title: Prognostic value of lymph node ratio in patients with small-cell carcinoma of the cervix based on data from a large national registry.
abstract: OBJECTIVE
  To investigate the prognostic value of the lymph node ratio (LNR) in patients with small-cell carcinoma of the cervix (SCCC) after cancer-directed surgery using a population-based national registry (Surveillance Epidemiology and End Results [SEER]).
  
  
  METHODS
  We retrospectively reviewed the data of SCCC patients in the SEER database from 1980 to 2012. The prognostic impact of LNR with respect to cause-specific survival (CSS) and overall survival (OS) was analyzed.
  
  
  RESULTS
  A total of 118 patients with SCCC were identified. The median follow-up was 30.5 months. All these patients were treated with cancer-directed surgery and lymphadenectomy. Sixty (50.8%) patients had nodal metastases. The median LNR was 0.16 in patients with positive lymph nodes. Univariate analysis showed that prognostic factors such as International Federation of Gynecology and Obstetrics (FIGO) stage, nodal status, LNR, and local treatment modalities affected CSS and OS (P<0.05). Multivariate analysis showed that LNR was an independent prognostic factor for CSS and OS. Patients with a higher LNR had worse CSS (hazard ratio [HR]: 8.832; 95% confidence interval [CI]: 3.762-20.738; P<0.001) and OS (HR: 8.462; 95% CI: 3.613-19.821; P<0.001). LNR was associated with CSS and OS by stage, especially in FIGO stage I-II patients.
  
  
  CONCLUSIONS
  LNR is an independent prognostic factor in SCCC patients and it may help to individualize adjuvant therapy.
authors.affiliation: Department of Obstetrics and Gynecology, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China.
authors.forename: Juan
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.
authors.forename: Jia-Yuan
authors.initials: JY
authors.lastname: Sun
authors.affiliation: Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China.
authors.forename: Shan-Yu
authors.initials: SY
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.
authors.forename: Feng-Yan
authors.initials: FY
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.
authors.forename: Huan-Xin
authors.initials: HX
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China.
authors.forename: San-Gang
authors.initials: SG
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.
authors.forename: Zhen-Yu
authors.initials: ZY
authors.lastname: He
keywords: SEER; lymph node; lymph node ratio; prognostic factors; small-cell carcinoma of the cervix