Clinical Impact of Pelvic Lymph Node Status in Locally Advanced Cervical Cancer Patients Treated by Concurrent Chemoradiation Therapy

OBJECTIVE: To explore the treatment outcomes of locally advanced cervical cancer (LACC) patients with pelvic lymph node enlargement (PLNE) or stage IIIC1 when compared with no PLNE and unknown PLN status (UNK). MATERIALS AND METHODS: Retrospective cohort study was designed by matching with the ratio of 1:4:4 for patients with PLNE, no PLNE and UNK between 2003 and 2017. The main factor which was used to match was clinical staging. RESULTS: All 360 LACC patients who treated as concurrent chemoradiation therapy (CCRT) were composed of 40 with PLNE, 160 with no PLNE and 160 with UNK. The majority of tumor histology (78.9%) was squamous cell carcinoma and 51.1% were diagnosed in stage IIB. Five-year progression free survival rates of patients with PLNE, no PLNE and UNK were 42.7%, 64.5% and 59.0%, respectively (P = 0.191), and corresponding with 5-year overall survival rates of 57.0%, 66.0% and 61.9% (P = 0.608). Patients with PLNE had local recurrence (LR) at 22.5%, compared with no PLNE at 11.3% and UNK at 11.9%. The most common site of LR for patients with PLNE was PLN with odds ratio of 19.7 when using no PLNE as reference (P < 0.001). There was no statistically significant difference between distant metastasis rates in PLN statuses of patients with PLNE, no PLNE and UNK at 20.6%, 30.0% and 26.3%, respectively. CONCLUSIONS: LACC patients with PLNE had a trend of poorer survival rates than patients with no PLNE, while treatment outcomes of patients with UNK were not inferior to no PLNE.