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Prognostic factors in locally advanced cervical cancer with pelvic lymph node metastasis
  1. Pedro Jorge Joffily Pinto1,
  2. Michael Jenwei Chen1,
  3. Elson Santos Neto1,
  4. Carlos Chaves Faloppa2,
  5. Louise De Brot3,
  6. Andrea Paiva Gadelha Guimaraes4,
  7. Alexandre Andre Balieiro Anastacio da Costa4 and
  8. Glauco Baiocchi2
  1. 1 Department of Radiation Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
  2. 2 Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
  3. 3 Department of Pathology, AC Camargo Cancer Center, São Paulo, Brazil
  4. 4 Department of Medical Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
  1. Correspondence to Dr Glauco Baiocchi, Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo 01509-010, Brazil; glauco.baiocchi{at}accamargo.org.br

Abstract

Objective To evaluate the prognostic impact of clinical and pathological variables and patterns of recurrence in patients with locally advanced cervical cancer with pelvic lymph node involvement (stage IIIC1 according to the 2018 FIGO Staging System).

Methods We retrospectively analyzed 62 patients with locally advanced cervical cancer treated with curative intent with radiotherapy associated with chemotherapy in AC Camargo Cancer Center from January 2007 to December 2018.

Results Lymph node involvement was assessed by CT, MRI and positron emission tomography (PET)/CT in 28 (45.2%), 20 (32.3%) and 14 (22.6%) patients, respectively. The median tumor size was 5.0 cm and 72.6% of cases were squamous cell carcinomas. The median number of positive pelvic lymph nodes was three, and the median size of lymph nodes was 24 mm. Twenty-two (35.5%) patients had recurrence and 50% had only one site of recurrence. The sites of recurrence were pelvic, para-aortic and distant in 12 (19.4%), 6 (9.7%) and 16 (25.8%) patients, respectively. The 3 year overall and disease-free survival were 70.8% and 64.6%, respectively. Patients with adenocarcinoma had worse disease-free survival (HR 2.38; 95% CI 1.01 to 5.60; p=0.047) and overall survival (HR 2.99; 95% CI 1.14 to 7.75; p=0.025) compared with squamous cell carcinoma. In multivariate analysis, metastatic pelvic lymph node size of >2.5 cm (HR 4.38; 95% CI 1.65 to 11.6; p=0.003) and incomplete response to radiotherapy (HR 5.14; 95% CI 1.60 to 16.4; p=0.006) maintained the negative impact for overall survival.

Conclusions We found that pelvic lymph node size and incomplete response to radiotherapy negatively impact overall survival in patients with advanced cervical cancer with pelvic lymph node involvement. This finding may help to stratify risk in this group of patients.

  • cervical cancer
  • radiation oncology
  • neoplasm recurrence
  • local

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @glaucobaiocchi

  • Contributors Study concept and design: PP, MJC, GB, ESN. Data acquisition: PP, GB, AdC, ESN, CF. Quality control of data: PP, LdB, GB, APGG, CF. Data analysis and interpretation: PP, MJC, GB. Statistical analysis: GB, PP, AdC. Manuscript preparation and editing: PP, GB. Manuscript review: all authors. Responsible for the overall content as guarantor: GB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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