Objectives Lymph node metastases are now incorporated into the 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer. However, the number of positive lymph nodes (nLNM) or the lymph node ratio (LNR) might provide a better prediction of survival. The aim of this study is to establish the impact of nLNM and LNR on survival in early-stage cervical cancer patients after surgery.

Methods In this population-based study, we selected all women diagnosed between 1995–2020 with FIGO 2009 stage IA2-IIA1 cervical cancer and nodal metastases after radical hysterectomy and pelvic lymphadenectomy from the Netherlands Cancer Registry. Optimal cut-offs for prognostic stratification by nLNM and LNR were calculated to categorize patients in low- or high-risk groups. Kaplan-Meier overall survival analysis and flexible parametric relative survival analysis were used to determine the impact of nLNM and LNR on survival. Missing data were imputed.

Results Of 593 patients, 500 and 501 (84%) were categorized in the low-risk and 93 and 92 (16%) in the high-risk groups for nLNM (≥4) and LNR (≥0.177), respectively. Both high-risk groups had a worse 5-year overall survival (p<0.001) and were, together with non-squamous histology, independent risk factors for relative survival, with excess hazard ratios of 2.4 (95% CI 1.6–3.5) for nLNM and 2.5 (95% CI 1.7–3.8) for LNR.

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Abstract EPV040/#185 Figure 1

Kaplan-Meier curves, 5-year overall survival categorizes by (A) nLNM risk-groups and (B) LNR risk-groups.

Conclusions Presenting a patient’s nodal status postoperatively by the number of positive nodes, or by its ratio, can support further risk stratification regarding survival in case of node-positive early-stage cervical cancer.