Number of lymph node in early-stage cervical cancer after radical surgery, does it matter?

Objective: To determine the number of lymph nodes obtained from radical hysterectomy with pelvic lymphadenectomy (RHPL) and survival rates of the early-stage cervical cancer patients with various numbers of removed lymph nodes (RLNs) and metastatic lymph nodes (MLNs). Materials and methods: 407 patients with early-stage cervical cancers who underwent RHPL were included in this study. We reviewed all medical records from January 2005-June 2020 and excluded the patients who had incomplete medical record, loss of follow-up visits and received neo-adjuvant chemotherapy. Results: Three-hundred-and-fifty-four patients were analyzed. The median time of follow-up was 44.3 months, the average number of RLNs was 23 (range 7-29) and 91.7% of our cases had >12 RLNs. MLNs were found in 36 cases (1 0.2%). The patients with RLNs <12 had a significantly lower 5-year cancer-specific survival (CSS) compared to those with RLNs >12 (73.6 % and 97.0%, respectively, p-value < 0.001) but 5-year progression-free survival (PFS) was not different between both groups. Based on lymph node status, the 5-year PFS and CSS of node-negative vs. node-positive patients were 99.3% vs. 76.2% and 97.5% vs. 74.0%, respectively. Conclusion: An extensive lymphadenectomy had a survival benefit in early-stage cervical cancer patients. The patients with RLNs >12 had better 5-year CSS. MLNs and RLNs <12 are significant prognostic factors for PFS and CSS.