The Prognostic Significance of Multiple Pelvic Node Metastases in Cervical Cancer Patients Treated with Radical Hysterectomy Plus Adjuvant Chemoradiotherapy

ABSTRACT Background Lymph node metastasis is an important prognostic factor in cervical cancer. According to previous reports, the survival of early-stage cervical cancer patients with three or more positive nodes was significantly shorter than that of those with one or two positive nodes, indicating the prognostic significance of multiple pelvic node metastases. However, because these previous investigations were conducted before the introduction of concurrent chemoradiotherapy (CCRT), the prognostic significance of multiple pelvic node metastases in patients treated with CCRT is unknown. We investigated the prognostic significance of multiple pelvic node metastases in cervical cancer patients who were treated with radical hysterectomy plus adjuvant CCRT. Methods We retrospectively reviewed the medical records of 311 patients with FIGO stage IB1–IIB cervical cancer who had been treated with radical hysterectomy plus adjuvant RT between April 1996 and December 2008. Of these, 119 received adjuvant RT alone (RT group) and 192 received CCRT (CCRT group). Multivariate analysis for progression-free survival (PFS) was carried out using the Cox proportional hazards regression model. Survival was calculated using the Kaplan–Meier method and compared using the log-rank test. Results Multivariate analysis demonstrated pelvic node metastasis to be an independent prognostic factor for shorter PFS in both groups. When the node-positive patients were analyzed according to the number of positive pelvic nodes, we found that the patients with multiple pelvic node metastases (>3) displayed significantly shorter PFS than those with 1 or 2 pelvic node metastases in the RT group. In contrast, in the CCRT-group, the PFS of the patients with multiple pelvic node metastases (>3) was similar to that observed of the patients with 1 or 2 pelvic node metastases. Conclusions The presence of multiple pelvic node metastases was not an independent predictor of shorter PFS in the CCRT group.