Significance of number of positive lymph nodes and size as prognostic factors of recurrence and overall survival in cervical cancer patients

Objectives: Although not included in the formal staging of cervical cancer, lymph node status is a known prognostic factor that greatly impacts survival. The aim of this study was to investigate the number and size of positive lymph nodes as independent prognostic factors of disease recurrence and overall survival (OS) in cervical cancer patients undergoing definitive chemo-radiation therapy (CRT). Materials and Methods: The present authors reviewed the clinical data of eligible women with loco-regionally confined, Stages IB1 through IVA, intact cervical cancer who received definitive CRT at Northwestern Memorial Hospital between January 1997 and September 2009. All women underwent definitive CRT with combined external beam radiation and brachy therapy. Probabilities for risk of recurrence were calculated relative to clinico-pathological variables. OS rates were obtained via the Kaplan-Meier method and differences between groups were analyzed using the log-rank test. Results: The authors identified 109 women during the study period with cervical cancer Stages IB1 through IVA treated definitively with CRT who met all inclusion criteria. The incidence of positive lymph nodes in the entire patient population was 42% (46 out of 109 cases). Advanced tumor stage was significantly associated with an increase in number of metastatic nodes (p = 0.02) and lymph node size (p = 0.04). The number of positive lymph nodes at the time of diagnosis was found to significantly impact risk of recurrence (p = 0.03). The present analysis revealed that patients with only one positive lymph node had a significantly lower risk of recurrence than those with >1 nodes, 25% vs. 58% (p = 0.04). Comparatively, lymph node size had no significant influence on recurrence (p = 0.45). Conclusion: Incremental increases in metastatic lymph node number at time of diagnosis correlated with worsening loco-regional control and OS. On the contrary, lymph node size was not found to be an independent prognostic factor for recurrence or survival.