The Characteristics and Survival of Patients with Mesorectum Metastatic Lymph Nodes from Cervical Cancer

PURPOSE: To analyze the characteristics and survival of patients with mesorectum metastatic lymph nodes (MLNs) from cervical cancer. PATIENTS AND METHODS: We retrospectively reviewed 1194 consecutive patients with FIGO stage IA–IVA cervical cancer who were treated with definitive radiotherapy between January 2011 and December 2015 in our institute. Patients were treated with intensity-modulated radiation therapy (IMRT) and brachytherapy, combined with concurrent chemotherapy. Mesorectum, pelvic and para-aortic MLNs were boosted 59–61Gy with IMRT. We calculated the clinical characteristics and survival of the patients with and without mesorectum MLNs and made comparisons between them. RESULTS: The incidence rate of mesorectum MLNs was 0.8% (10/1194). The incidence rates for patients with FIGO stages I, II, III, and IVA disease were 0%, 0.4%, 2.0%, and 33.3%, respectively. Mesorectum MLNs were associated with more advanced stage (p <0.001); larger tumor size (p = 0.002), para-aortic MLNs (p <0.001), common iliac MLNs (p <0.001), and bilateral pelvic MLNs (p <0.001). All patients with mesorectum MLNs experienced treatment failure and died during follow-up. The median overall survival was 10.43 months. The 2-year overall survival (OS), disease-free survival (DFS), and local control (LC) rates were 10%, 0%, and 30%, respectively. Multivariate analysis showed that that mesorectum MLNs (hazard ratio, HR 4.0, 95% CI 1.8–9.1, p=0.001), para-aortic MLNs (HR 1.8, 95% CI 1.1–2.8, p=0.017) and pelvic MLNs (HR 2.5, 95% CI 1.7–3.7, p<0.001) were independent prognostic factors of OS. CONCLUSION: Mesorectum MLNs from cervical cancer are rare. And, the survival of patients with mesorectum MLNs was poor after dose-escalated concurrent chemoradiotherapy.