Prognostic significance of lymph node ratio in node-positive cervical cancer patients

To determine whether the pelvic lymph node ratio (LNR) has significant prognostic value for survival and disease recurrence in node-positive, early stage cervical cancer patients. The medical records of 872 consecutive women who received postoperative adjuvant chemoradiotherapy were reviewed. Of these, 397 women with pathologically proven lymph nodal metastasis were included in this analysis and categorized into 3 groups according to their LNR: low (<0.1, n = 251), intermediate (0.1–0.4, n = 121), and high (>0.4, n = 25). The association between LNR and oncological outcome was evaluated using the Kaplan–Meier method and multivariate analysis. A total of 13,491 LNs were retrieved from 397 women, with a median harvest of 32 nodes per patient. There was a strong positive correlation between the number of metastatic LNs and LNR (r = 0.83, P < .01). With a median follow-up duration of 48 months, the 5-year overall survival (OS) and disease-free survival (DFS) rates were 73% and 67%, respectively. The OS and DFS curves among the pelvic LNR groups significantly differed: the 5-year OS rates of the low, intermediate, and high pelvic LNR groups were 83%, 66%, and 17% (P < .01), and the 5-year DFS rates were 77%, 56%, and 20% (P < .01), respectively. LNR is an important prognostic factor for survival outcomes in patients with uterine cervical cancer who underwent radical hysterectomy followed by adjuvant chemoradiotherapy.