Cancer Research and Treatment

Original Articles

Pretreatment Lymph Node Metastasis as a Prognostic Significance in Cervical Cancer: Comparison between Disease Status: Soo Young Jeong, Hyea Park, Myeong Seon Kim, Jun Hyeok Kang, E Sun Paik, Yoo-Young Lee, Tae Joong Kim, Jeong Won Lee, Byoung-Gie Kim, Duk Soo Bae, Chel Hun Choi; Cancer Res Treat. 2020;52(2):516-523. Published online October 29, 2019; DOI: https://doi.org/10.4143/crt.2019.328

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Purpose
Lymph node metastasis (LNM) is the most significant prognostic factor in cervical cancer that was recently incorporated into the International Federation of Gynecology and Obstetrics (FIGO) staging system. This study was performed to evaluate whether the prognostic significance of LNM differs according to disease status.
Materials and Methods
Patients with FIGO stage IB or higher cervical cancer who had pretreatment computed tomography and/or magnetic resonance imaging studies as well as long-term follow-up were enrolled in this retrospective study. The hazard ratio (HR) of Cox regression was used to determine the prognostic significance of LNM. The HRs were compared between the different tumor groups (based on stage, histology, tumor size, primary treatment, age, parametrium involvement, and lymphovascular space invasion).
Results
A total of 970 patients treated between January 1999 and December 2007 were included. The pretreatment LNM had prognostic significance in patients with stage IB1/IIA (HR for progression-free survival 2.10, p=0.001; HR for overall survival 1.99, p=0.005). However, the significance gradually decreased or disappeared with advancing stages. Similarly, the prognostic significance of the pretreatment LNM decreased with advancing disease status, including old age, parametrial involvement or lymphovascular space involvement. In contrast, the tumor size was associated with the prognostic significance of LNM with advancing status. The significance of the clinical LNM did not reflect the significance of the clinical stage. In contrast, the tumor size, parametrial involvement, and significance of the pathologic LNM reflected the clinical stage.
Conclusion
In patients with cervical cancer, pretreatment LNM on imaging has different clinical significance depending on the tumor status.

Citations

Citations to this article as recorded by

Predicting the risk of lymph node metastasis in colon cancer: development and validation of an online dynamic nomogram based on multiple preoperative data
Longlian Deng, Lemuge Che, Haibin Sun, Riletu En, Bowen Ha, Tao Liu, Tengqi Wang, Qiang Xu
BMC Gastroenterology.2025;[Epub] CrossRef
Complete remission of a high-risk, locally advanced cervical cancer with para-aortic lymph node metastases treated with first-line tislelizumab plus bevacizumab combined with chemotherapy followed by radiotherapy with maintenance therapy: a case report
Juan Lang, Qianqian Liu, Rong Ji, Miao Qiu, Siben Wang, Qingmeng Liu, Dapeng Li, Ping Chen, Zhongkui Xiong
Frontiers in Immunology.2025;[Epub] CrossRef
Application of CT in predicting lymph node metastasis in cervical cancer and construction of a preoperative nomogram
Xiao Meng, Siyu Song, Ke Li, Yajie Duan, Jiayuan Zhong, Jiawei Wang, Shichao Han
Scientific Reports.2025;[Epub] CrossRef
Development of cervical intraepithelial neoplasia and invasive cervical cancer due to oxidative stress
Amir Asotić, Memić Asotić, Muhamed Memić, Kerim Asotić, Amra Asotić
Sanamed.2024; 19(1): 39. CrossRef
Investigating and Analyzing Prognostic Factors and Their Impact on Recurrent Cervical Cancers
Ashish Uke, Shweta B Dahake, Anurag Luharia, Monika Luharia, Gaurav V Mishra, Chanrashekhar Mahakalkar
Cureus.2024;[Epub] CrossRef
Based on 3D-PDU and clinical characteristics nomogram for prediction of lymph node metastasis and lymph-vascular space invasion of early cervical cancer preoperatively
Shuang Dong, Yan-Qing Peng, Ya-Nan Feng, Xiao-Ying Li, Li-Ping Gong, Shuang Zhang, Xiao-Shan Du, Li-Tao Sun
BMC Women's Health.2024;[Epub] CrossRef
Recent Advances in Cervical Cancer Management: A Review on Novel Prognostic Factors in Primary and Recurrent Tumors
Angela Santoro, Frediano Inzani, Giuseppe Angelico, Damiano Arciuolo, Emma Bragantini, Antonio Travaglino, Michele Valente, Nicoletta D’Alessandris, Giulia Scaglione, Stefania Sfregola, Alessia Piermattei, Federica Cianfrini, Paola Roberti, Gian Franco Za
Cancers.2023; 15(4): 1137. CrossRef
Identification of lymph node metastasis in pre‐operation cervical cancer patients by weakly supervised deep learning from histopathological whole‐slide biopsy images
Qingqing Liu, Nan Jiang, Yiping Hao, Chunyan Hao, Wei Wang, Tingting Bian, Xiaohong Wang, Hua Li, Yan zhang, Yanjun Kang, Fengxiang Xie, Yawen Li, XuJi Jiang, Yuan Feng, Zhonghao Mao, Qi Wang, Qun Gao, Wenjing Zhang, Baoxia Cui, Taotao Dong
Cancer Medicine.2023; 12(17): 17952. CrossRef
Roles of DWI and T2-weighted MRI volumetry in the evaluation of lymph node metastasis and lymphovascular invasion of stage IB–IIA cervical cancer
Y. Wang, X. Chen, H. Pu, Y. Yuan, S. Li, G. Chen, Y. Liu, H. Li
Clinical Radiology.2022; 77(3): 224. CrossRef
Risk Factor Assessment of Lymph Node Metastasis in Patients With FIGO Stage IB1 Cervical Cancer
Mu Xu, Xiaoyan Xie, Liangzhi Cai, Yongjin Xie, Qiao Gao, Pengming Sun
Frontiers in Oncology.2022;[Epub] CrossRef
Intravoxel Incoherent Motion (IVIM) MR Quantification in Locally Advanced Cervical Cancer (LACC): Preliminary Study on Assessment of Tumor Aggressiveness and Response to Neoadjuvant Chemotherapy
Miriam Dolciami, Silvia Capuani, Veronica Celli, Alessandra Maiuro, Angelina Pernazza, Innocenza Palaia, Violante Di Donato, Giusi Santangelo, Stefania Maria Rita Rizzo, Paolo Ricci, Carlo Della Rocca, Carlo Catalano, Lucia Manganaro
Journal of Personalized Medicine.2022; 12(4): 638. CrossRef
The prognostic significance of pretreatment squamous cell carcinoma antigen levels in cervical cancer patients treated by concurrent chemoradiation therapy and a comparison of dosimetric outcomes and clinical toxicities between tomotherapy and volumetric
Yuan-Kai Cheng, Shih-Hsun Kuo, Heng-Hsuan Yen, Jing-Hu Wu, Yu-Chieh Chen, Ming-Yii Huang
Radiation Oncology.2022;[Epub] CrossRef
What MRI-based tumor size measurement is best for predicting long-term survival in uterine cervical cancer?
Njål Lura, Kari S. Wagner-Larsen, David Forsse, Jone Trovik, Mari K. Halle, Bjørn I. Bertelsen, Øyvind Salvesen, Kathrine Woie, Camilla Krakstad, Ingfrid S. Haldorsen
Insights into Imaging.2022;[Epub] CrossRef
Clinical value of MRI, serum SCCA, and CA125 levels in the diagnosis of lymph node metastasis and para-uterine infiltration in cervical cancer
Chao Ran, Jian Sun, Yunhui Qu, Na Long
World Journal of Surgical Oncology.2021;[Epub] CrossRef
A Novel Four-Gene Prognostic Signature as a Risk Biomarker in Cervical Cancer
Jun Wang, Hua Zheng, Yatian Han, Geng Wang, Yanbin Li, Cuida Meng
International Journal of Genomics.2020; 2020: 1. CrossRef

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Prognostic Value of Different Patterns of Squamous Cell Carcinoma Antigen Level for the Recurrent Cervical Cancer: Bae Kwon Jeong, Seung Jae Huh, Doo Ho Choi, Won Park, Duk Soo Bae, Byoung-Gie Kim; Cancer Res Treat. 2013;45(1):48-54. Published online March 31, 2013; DOI: https://doi.org/10.4143/crt.2013.45.1.48

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PURPOSE
In some unusual cases, in patients with cervical cancer, an elevation of squamous cell carcinoma antigen (SCC-Ag) was not observed at diagnosis but was observed on recurrence, or vice versa. The objective of this study was to identify patient-, disease-, and treatment-related factors associated with this unusual level of SCC-Ag, and to determine whether SCC-Ag is a useful tumor marker in such patients.
MATERIALS AND METHODS
Among 129 patients with recurrence, 14 who showed a normal SCC-Ag level at diagnosis but an elevated level at recurrence were classified as group I; 22 patients with an elevated SCC-Ag level at diagnosis but not at recurrence were classified as group II; and 76 patients with an elevated SCC-Ag level at both diagnosis and recurrence were classified as group III.
RESULTS
In univariate analysis, unusual SCC-Ag showed statistically significant relationships with pathology and biochemical response to treatment. However, in the multivariate analysis, none of the clinicopathologic factors showed a statistical relationship with unusual levels of SCC-Ag. The 5-year disease-free survival rates for groups I, II, and III were 7.1%, 9.1%, and 0% (p=0.418), and the 5-year overall survival rates were 34.3%, 58.4%, and 33.3% (p=0.142), respectively.
CONCLUSION
The value of SCC-Ag has been confirmed in all patients; thus, check of SCC-Ag level at follow-up should be considered. Although no statistically significant differences were observed among the groups, we conclude that patients with a high initial SCC-Ag and elevated SCC-Ag at relapse have poor prognosis due to high SCC-Ag level.

Citations

Citations to this article as recorded by

Predictors of distant metastasis or local recurrent after radiotherapy in patients with cervical cancer
Chufan Wu, Xiaojuan Lv, Fangfang Wang, Qing Xu, Hanmei Lou, Xiaojing Zhang
BMC Cancer.2025;[Epub] CrossRef
Use of squamous cell carcinoma antigen in the management of cervical cancer
Lucas Adalberto Geraldi Zanini, Daniel Simon, Reitan Ribeiro
Jornal Brasileiro de Ginecologia.2025;[Epub] CrossRef
Utility of vaginal vault cytology in the local recurrence of cervical cancer
Kazuto Nakamura, Soichi Yamashita, Keiko Kigure, Toshio Nishimura, Ikuro Ito, Anri Azuma, Kohshiro Nakao, Ken Ando, Tatsuya Kanuma
BMC Women's Health.2023;[Epub] CrossRef
Study on the preoperative value of serum SCC-Ag in predicting the stromal invasion of cervical squamous cell carcinoma
Lin Qin
Journal of Cancer Research and Clinical Oncology.2023; 149(11): 9167. CrossRef
Prognostic Effect of Primary Recurrence Patterns in Squamous Cervical Carcinoma After Radical Surgery
Zongkai Zhang, Long Jiang, Rui Bi, Xiaohua Wu, Guihao Ke, Jun Zhu
Frontiers in Oncology.2022;[Epub] CrossRef
Can serial evaluation of serum SCC-Ag-level predict tumor recurrence and patient survival in squamous-cell carcinoma of uterine cervix treated with definitive chemoradiotherapy? A multi-institutional analysis
Kyu Hye Choi, Mina Yu, Songmi Jeong, Jong Hoon Lee
International Journal of Clinical Oncology.2020; 25(7): 1405. CrossRef
Preoperative SCC-Ag as a predictive marker for the use of adjuvant chemotherapy in cervical squamous cell carcinoma with intermediate-risk factors
Hong-tao Guo, Xue-han Bi, Ting Lei, Xiao Lv, Guang Yao, Yao Chen, Chang Liu
BMC Cancer.2020;[Epub] CrossRef
Significance of elevated SCC-Ag level on tumor recurrence and patient survival in patients with squamous-cell carcinoma of uterine cervix following definitive chemoradiotherapy: a multi-institutional analysis
Kyu Hye Choi, Sea-Won Lee, Mina Yu, Songmi Jeong, Jeong Won Lee, Jong Hoon Lee
Journal of Gynecologic Oncology.2019;[Epub] CrossRef
Prognostic Role of Squamous Cell Carcinoma Antigen in Cervical Cancer: A Meta-analysis
Zhenhua Liu, Hongtai Shi
Disease Markers.2019; 2019: 1. CrossRef
The association between serum squamous cell carcinoma antigen and recurrence and survival of patients with cervical squamous cell carcinoma: A systematic review and meta-analysis
Chuenkamon Charakorn, Kunlawat Thadanipon, Sawarat Chaijindaratana, Sasivimol Rattanasiri, Pawin Numthavaj, Ammarin Thakkinstian
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Squamous cell carcinoma antigen expression in tumor cells is associated with the chemosensitivity and survival of patients with cervical cancer receiving docetaxel-carboplatin-based neoadjuvant chemotherapy
Peng Chen, Liang Jiao, Dan-Bo Wang
Oncology Letters.2017; 13(3): 1235. CrossRef
C14ORF166 overexpression is associated with pelvic lymph node metastasis and poor prognosis in uterine cervical cancer
Weijing Zhang, Jianping Ou, Fangyong Lei, Teng Hou, Shu Wu, Chunhao Niu, Liqun Xu, Yanna Zhang
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The assessment of the prognostic value of tumor markers and cytokines as SCCAg, CYFRA 21.1, IL-6, VEGF and sTNF receptors in patients with squamous cell cervical cancer, particularly with early stage of the disease
Beata Kotowicz, Malgorzata Fuksiewicz, Joanna Jonska-Gmyrek, Mariusz Bidzinski, Maria Kowalska
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The Value of Diffusion-Weighted Imaging in Predicting the Prognosis of Stage IB-IIA Cervical Squamous Cell Carcinoma After Radical Hysterectomy
Guoxing Zhou, Xiao Chen, Fei Tang, Jie Zhou, Yibin Wang, Zhongqiu Wang
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Relationship of 18F-Fdg Pet/Ct Metabolic, Clinical and Pathological Characteristics of Primary Squamous Cell Carcinoma of the Cervix
Weina Xu, Shupeng Yu, Jun Xin, Qiyong Guo
Journal of Investigative Medicine.2016; 64(8): 1246. CrossRef
Ultrasensitive nonenzymatic immunosensor based on bimetallic gold–silver nanoclusters synthesized by simple mortar grinding route
Xiaoyue Zhang, Feng Li, Qin Wei, Bin Du, Dan Wu, He Li
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Detection of cervical cancer recurrence during follow-up: A multivariable comparison of 9 frequently investigated serum biomarkers
Jacob P. Hoogendam, Afra Zaal, Emma G.G.M. Rutten, Cobi J. Heijnen, Gemma G. Kenter, Wouter B. Veldhuis, René H.M. Verheijen, Ronald P. Zweemer
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Radical Radiotherapy for Locally Advanced Cancer of Uterine Cervix: Jeung Eun Lee, Seung Jae Huh, Won Park, Do Hoon Lim, Yong Chan Ahn, Chang Soo Park, Byoung Gie Kim, Duk Soo Bae, Je Ho Lee, Chong Taik Park, Tae Jin Kim, Kyung Taek Lim, Hwan Wook Chung, Ki Heon Lee, Jae Uk Shim; Cancer Res Treat. 2004;36(4):222-227. Published online August 31, 2004; DOI: https://doi.org/10.4143/crt.2004.36.4.222

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Purpose

This study was performed to evaluate the treatment results, prognostic factors and complication rates in patients with locally advanced cancer of uterine cervix after radiotherapy with high-dose rate (HDR) brachytherapy.

Materials and Methods

One hundred and twenty patients with a locally advanced (stages IIB~IVA according to FIGO classification) carcinoma of the uterine cervix were treated with radiotherapy at the Department of Radiation Oncology, Samsung Medical Center between September 1994 and December 2001. The median age of the patients was 61 years (range 29 to 81). Sixty-one, 56 and 3 patients had FIGO stage IIB, III, and IV diseases, respectively. All patients were given external beam radiotherapy over the whole pelvis (median 50.4 Gy) and HDR intracavitary brachytherapy, with a median of 4 Gy per fraction, to point A. Twenty-one patients received chemotherapy, of which 13 and 21 received neoadjuvant chemotherapy and concurrent chemotherapy, respectively, during the first and fourth weeks of external beam radiotherapy. The chemotherapy was not randomly assigned and the median follow-up time was 28.5 months (range: 6~100 months).

Results

The three- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 64.4 and 57.0%, and 63.7 and 60.2%, respectively. The 5-year OS and DFS rates of the patients at stages IIB, III and IV were 60.2, 57.9 and 33.3%, and 57.4, 65.4 and 33.3%, respectively. Univariate analysis indicated that the FIGO stage, overall treatment time (OTT) and treatment response were significant variables for the OS (p=0.035, p=0.0649 and p=0.0009) and of the DFS (p=0.0009, p=0.0359 and p=0.0363). Multivariate analysis showed that the treatment response was the only significant variable for the OS (p=0.0018) and OTT for the DFS (p=0.0360). The overall incidence of late complications in the rectum and bladder were 11.7 and 6.7%, respectively. In addition, insufficiency fractures were observed in 7 patients (5.8%).

Conclusion

The results of this study suggest that radical radiotherapy with HDR brachytherapy was appropriate for the treatment of locally advanced uterine cervix cancer. Also, the response after treatment and OTT are significant prognostic factors.

Citations

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Bilateral cervical cancer in a complete septate uterus with a double cervix and vagina: a case report
Li Wang, Zi Liu
Journal of International Medical Research.2023;[Epub] CrossRef
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Eleonor Rivin del Campo, Oscar Matzinger, Karin Haustermans, Didier Peiffert, Robert Glynne-Jones, Kathryn A. Winter, Andre A. Konski, Jaffer A. Ajani, Jean-François Bosset, Jean-Michel Hannoun-Levi, Marc Puyraveau, A. Bapsi Chakravarthy, Helen Meadows, J
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Predictors of Radiation Field Failure After Definitive Chemoradiation in Patients With Locally Advanced Cervical Cancer
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