LymphedemaV1, Pmc, Corpus, bibRecord, 003314

Significance of Lymph Node Ratio in Defining Risk Category in Node-positive Early Stage Cervical Cancer

Identifieur interne : 003314 ( Pmc/Corpus ); précédent : 003313; suivant : 003315

Significance of Lymph Node Ratio in Defining Risk Category in Node-positive Early Stage Cervical Cancer

Auteurs : Nicole D. Fleming ; Michael Frumovitz ; Kathleen M. Schmeler ; Ricardo Dos Reis ; Mark F. Munsell ; Patricia J. Eifel ; Pamela T. Soliman ; Alpa M. Nick ; Shannon N. Westin ; Pedro T. Ramirez

Source :

Gynecologic oncology [ 0090-8258 ] ; 2014.

RBID : PMC:4430191

Abstract

Objective

The ratio of positive to negative lymph nodes, or lymph node ratio (LNR), is an important prognostic factor in several solid tumors. The objective of this study was to determine if LNR can be used to define a high-risk category of patients with node-positive early stage cervical cancer.

Methods

We performed a retrospective review of patients diagnosed with node-positive stage I or II cervical cancer who underwent radical hysterectomy and pelvic +/− para-aortic lymphadenectomy at MD Anderson from January 1990 through December 2011. Univariate and multivariate analysis was used to identify prognostic factors for progression-free (PFS) and overall survival (OS).

Results

Ninety-five patients met inclusion criteria and were included in the analysis. Median total nodes removed were 19 (range 1–58), and median number of positive nodes was 1 (range 1–12). Fifty-eight patients (61%) received radiation with concurrent cisplatin and 27 patients (28%) received radiotherapy alone. Twenty-one (22%) patients recurred. On multivariate analysis, a LNR > 6.6% was associated with a worse PFS (HR=2.97, 95% CI 1.26–7.02, p=0.01), and a LNR > 7.6% with a worse OS (HR=3.96, 95% CI 1.31–11.98, p=0.01). On multivariate analysis, positive margins were associated with worse PFS (p=0.001) and OS (p=0.002), and adjuvant radiotherapy (p=0.01) with improved OS.

Conclusions

LNR appears to be a useful tool to identify patients with worse prognosis in node-positive early stage cervical cancer. LNR may be used in addition to pathologic risk factors to tailor adjuvant treatment in this population.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430191

DOI: 10.1016/j.ygyno.2014.11.010
PubMed: 25451695
PubMed Central: 4430191

Links to Exploration step

PMC:4430191

Le document en format XML

<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Significance of Lymph Node Ratio in Defining Risk Category in Node-positive Early Stage Cervical Cancer</title>
<author><name sortKey="Fleming, Nicole D" sort="Fleming, Nicole D" uniqKey="Fleming N" first="Nicole D." last="Fleming">Nicole D. Fleming</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Frumovitz, Michael" sort="Frumovitz, Michael" uniqKey="Frumovitz M" first="Michael" last="Frumovitz">Michael Frumovitz</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Schmeler, Kathleen M" sort="Schmeler, Kathleen M" uniqKey="Schmeler K" first="Kathleen M." last="Schmeler">Kathleen M. Schmeler</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Dos Reis, Ricardo" sort="Dos Reis, Ricardo" uniqKey="Dos Reis R" first="Ricardo" last="Dos Reis">Ricardo Dos Reis</name>
<affiliation><nlm:aff id="A2">Department of Gynecologic Oncology, Hospital de Cancer de Barretos, Sao Paulo, Brazil</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Munsell, Mark F" sort="Munsell, Mark F" uniqKey="Munsell M" first="Mark F." last="Munsell">Mark F. Munsell</name>
<affiliation><nlm:aff id="A3">Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Eifel, Patricia J" sort="Eifel, Patricia J" uniqKey="Eifel P" first="Patricia J." last="Eifel">Patricia J. Eifel</name>
<affiliation><nlm:aff id="A4">Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Soliman, Pamela T" sort="Soliman, Pamela T" uniqKey="Soliman P" first="Pamela T." last="Soliman">Pamela T. Soliman</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Nick, Alpa M" sort="Nick, Alpa M" uniqKey="Nick A" first="Alpa M." last="Nick">Alpa M. Nick</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Westin, Shannon N" sort="Westin, Shannon N" uniqKey="Westin S" first="Shannon N." last="Westin">Shannon N. Westin</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ramirez, Pedro T" sort="Ramirez, Pedro T" uniqKey="Ramirez P" first="Pedro T." last="Ramirez">Pedro T. Ramirez</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Significance of Lymph Node Ratio in Defining Risk Category in Node-positive Early Stage Cervical Cancer</title>
<author><name sortKey="Fleming, Nicole D" sort="Fleming, Nicole D" uniqKey="Fleming N" first="Nicole D." last="Fleming">Nicole D. Fleming</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Frumovitz, Michael" sort="Frumovitz, Michael" uniqKey="Frumovitz M" first="Michael" last="Frumovitz">Michael Frumovitz</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Schmeler, Kathleen M" sort="Schmeler, Kathleen M" uniqKey="Schmeler K" first="Kathleen M." last="Schmeler">Kathleen M. Schmeler</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Dos Reis, Ricardo" sort="Dos Reis, Ricardo" uniqKey="Dos Reis R" first="Ricardo" last="Dos Reis">Ricardo Dos Reis</name>
<affiliation><nlm:aff id="A2">Department of Gynecologic Oncology, Hospital de Cancer de Barretos, Sao Paulo, Brazil</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Munsell, Mark F" sort="Munsell, Mark F" uniqKey="Munsell M" first="Mark F." last="Munsell">Mark F. Munsell</name>
<affiliation><nlm:aff id="A3">Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Eifel, Patricia J" sort="Eifel, Patricia J" uniqKey="Eifel P" first="Patricia J." last="Eifel">Patricia J. Eifel</name>
<affiliation><nlm:aff id="A4">Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Soliman, Pamela T" sort="Soliman, Pamela T" uniqKey="Soliman P" first="Pamela T." last="Soliman">Pamela T. Soliman</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Nick, Alpa M" sort="Nick, Alpa M" uniqKey="Nick A" first="Alpa M." last="Nick">Alpa M. Nick</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Westin, Shannon N" sort="Westin, Shannon N" uniqKey="Westin S" first="Shannon N." last="Westin">Shannon N. Westin</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ramirez, Pedro T" sort="Ramirez, Pedro T" uniqKey="Ramirez P" first="Pedro T." last="Ramirez">Pedro T. Ramirez</name>
<affiliation><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Gynecologic oncology</title>
<idno type="ISSN">0090-8258</idno>
<idno type="eISSN">1095-6859</idno>
<imprint><date when="2014">2014</date>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title>
<p id="P2">The ratio of positive to negative lymph nodes, or lymph node ratio (LNR), is an important prognostic factor in several solid tumors. The objective of this study was to determine if LNR can be used to define a high-risk category of patients with node-positive early stage cervical cancer.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P3">We performed a retrospective review of patients diagnosed with node-positive stage I or II cervical cancer who underwent radical hysterectomy and pelvic +/− para-aortic lymphadenectomy at MD Anderson from January 1990 through December 2011. Univariate and multivariate analysis was used to identify prognostic factors for progression-free (PFS) and overall survival (OS).</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P4">Ninety-five patients met inclusion criteria and were included in the analysis. Median total nodes removed were 19 (range 1–58), and median number of positive nodes was 1 (range 1–12). Fifty-eight patients (61%) received radiation with concurrent cisplatin and 27 patients (28%) received radiotherapy alone. Twenty-one (22%) patients recurred. On multivariate analysis, a LNR > 6.6% was associated with a worse PFS (HR=2.97, 95% CI 1.26–7.02, p=0.01), and a LNR > 7.6% with a worse OS (HR=3.96, 95% CI 1.31–11.98, p=0.01). On multivariate analysis, positive margins were associated with worse PFS (p=0.001) and OS (p=0.002), and adjuvant radiotherapy (p=0.01) with improved OS.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P5">LNR appears to be a useful tool to identify patients with worse prognosis in node-positive early stage cervical cancer. LNR may be used in addition to pathologic risk factors to tailor adjuvant treatment in this population.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
  <pmc-dir>properties manuscript</pmc-dir>
  <front><journal-meta><journal-id journal-id-type="nlm-journal-id">0365304</journal-id>
<journal-id journal-id-type="pubmed-jr-id">3932</journal-id>
<journal-id journal-id-type="nlm-ta">Gynecol Oncol</journal-id>
<journal-id journal-id-type="iso-abbrev">Gynecol. Oncol.</journal-id>
<journal-title-group><journal-title>Gynecologic oncology</journal-title>
</journal-title-group>
<issn pub-type="ppub">0090-8258</issn>
<issn pub-type="epub">1095-6859</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">25451695</article-id>
<article-id pub-id-type="pmc">4430191</article-id>
<article-id pub-id-type="doi">10.1016/j.ygyno.2014.11.010</article-id>
<article-id pub-id-type="manuscript">NIHMS655473</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Significance of Lymph Node Ratio in Defining Risk Category in Node-positive Early Stage Cervical Cancer</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Fleming</surname>
<given-names>Nicole D.</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Frumovitz</surname>
<given-names>Michael</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Schmeler</surname>
<given-names>Kathleen M.</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>dos Reis</surname>
<given-names>Ricardo</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Munsell</surname>
<given-names>Mark F.</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Eifel</surname>
<given-names>Patricia J.</given-names>
</name>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Soliman</surname>
<given-names>Pamela T.</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nick</surname>
<given-names>Alpa M.</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Westin</surname>
<given-names>Shannon N.</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ramirez</surname>
<given-names>Pedro T.</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</aff>
<aff id="A2"><label>2</label>
Department of Gynecologic Oncology, Hospital de Cancer de Barretos, Sao Paulo, Brazil</aff>
<aff id="A3"><label>3</label>
Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</aff>
<aff id="A4"><label>4</label>
Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</aff>
<author-notes><corresp id="FN1">Please send correspondence to: Nicole D. Fleming, MD, 1155 Pressler Drive, Unit 1362, Houston, TX 77030, Phone: (713) 563-1792, Fax: (713) 745-1541, <email>nfleming@mdanderson.org</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>29</day>
<month>4</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="epub"><day>18</day>
<month>11</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="ppub"><month>1</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>01</day>
<month>1</month>
<year>2016</year>
</pub-date>
<volume>136</volume>
<issue>1</issue>
<fpage>48</fpage>
<lpage>53</lpage>
<pmc-comment>elocation-id from pubmed: 10.1016/j.ygyno.2014.11.010</pmc-comment>
      <permissions><copyright-statement>© 2014 Elsevier Inc. All rights reserved.</copyright-statement>
<copyright-year>2014</copyright-year>
</permissions>
<abstract><sec id="S1"><title>Objective</title>
<p id="P2">The ratio of positive to negative lymph nodes, or lymph node ratio (LNR), is an important prognostic factor in several solid tumors. The objective of this study was to determine if LNR can be used to define a high-risk category of patients with node-positive early stage cervical cancer.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P3">We performed a retrospective review of patients diagnosed with node-positive stage I or II cervical cancer who underwent radical hysterectomy and pelvic +/− para-aortic lymphadenectomy at MD Anderson from January 1990 through December 2011. Univariate and multivariate analysis was used to identify prognostic factors for progression-free (PFS) and overall survival (OS).</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P4">Ninety-five patients met inclusion criteria and were included in the analysis. Median total nodes removed were 19 (range 1–58), and median number of positive nodes was 1 (range 1–12). Fifty-eight patients (61%) received radiation with concurrent cisplatin and 27 patients (28%) received radiotherapy alone. Twenty-one (22%) patients recurred. On multivariate analysis, a LNR > 6.6% was associated with a worse PFS (HR=2.97, 95% CI 1.26–7.02, p=0.01), and a LNR > 7.6% with a worse OS (HR=3.96, 95% CI 1.31–11.98, p=0.01). On multivariate analysis, positive margins were associated with worse PFS (p=0.001) and OS (p=0.002), and adjuvant radiotherapy (p=0.01) with improved OS.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P5">LNR appears to be a useful tool to identify patients with worse prognosis in node-positive early stage cervical cancer. LNR may be used in addition to pathologic risk factors to tailor adjuvant treatment in this population.</p>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
</record>

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Significance of Lymph Node Ratio in Defining Risk Category in Node-positive Early Stage Cervical Cancer

Significance of Lymph Node Ratio in Defining Risk Category in Node-positive Early Stage Cervical Cancer

Source :

Abstract

Links to Exploration step

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