title: Further stratification of risk groups in patients with lymph node metastasis after radical hysterectomy for early-stage cervical cancer.
abstract: OBJECTIVE
  To determine the prognostic factors in node-positive patients with early-stage cervical cancer who underwent radical hysterectomy (RH) and to use these factors to stratify patients into risk groups for individualized adjuvant therapy.
  
  
  METHODS
  Patients with early-stage cervical cancer who had lymph node metastasis after RH were retrospectively analyzed.
  
  
  RESULTS
  Multivariate analysis showed that non-squamous histology, tumor size and parametrial involvement were significantly associated with recurrence-free survival (RFS) and overall survival (OS). Prognostic scores were generated for these factors, and patients were categorized into low- (score 0; n=74), intermediate- (score 1-2; n=100) and high- (score 3-4; n=14) risk groups. Relative to the low-risk group, the probability of cancer recurrence was significantly higher in the high- (OR=10.87, 95% CI=4.22-28.0, P<.001) and intermediate- (OR=3.01, 95% CI=1.37-6.58, P=.006) risk groups. Moreover, the probability of cancer death was significantly higher in the high- (OR=9.88, 95% CI=3.76-25.94, P<.001) and intermediate- (OR=2.49, 95% CI=1.12-5.55, P=.026) risk groups compared with the low-risk group. The rates of pelvic failure and distant recurrence increased with increasing risk.
  
  
  CONCLUSIONS
  Node-positive patients were heterogeneous, with different prognoses and recurrence patterns according to clinicopathologic risk factors. Further clinical trials are warranted to develop adjuvant treatment strategies individualized to each risk group.
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jeong-Yeol
authors.initials: JY
authors.lastname: Park
authors.forename: Dae-Yeon
authors.initials: DY
authors.lastname: Kim
authors.forename: Jong-Hyeok
authors.initials: JH
authors.lastname: Kim
authors.forename: Yong-Man
authors.initials: YM
authors.lastname: Kim
authors.forename: Young-Tak
authors.initials: YT
authors.lastname: Kim
authors.forename: Joo-Hyun
authors.initials: JH
authors.lastname: Nam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery