International Journal of Clinical Oncology

, Volume 16, Issue 1, pp 33–38 | Cite as

Survival and prognosticators of node-positive cervical cancer patients treated with radical hysterectomy and systematic lymphadenectomy

  • Masayoshi Hosaka
  • Hidemichi Watari
  • Takashi Mitamura
  • Yousuke Konno
  • Tetsuji Odagiri
  • Tatsuya Kato
  • Mahito Takeda
  • Noriaki Sakuragi
Original Article



Lymph node metastasis (LNM) is known to be the most important prognostic factor in cervical cancer. We analyzed the number of positive lymph nodes and other clinicopathological factors as prognostic factors for survival in node-positive patients with cervical cancer.


Node-positive cervical cancer patients (n = 108) who underwent radical hysterectomy and systematic lymphadenectomy in Hokkaido University Hospital from 1982 to 2002 were enrolled. Clinicopathological data including age, stage, histologic subtype, and the number of LNM sites were collected. The main outcome was the overall survival (OS) rate for Stage Ib–IIb patients treated with surgery and postoperative radiotherapy.


The 5-year OS rate of patients with 1 positive node was 93.3%, that for 2 nodes was 77.3%, for 3 nodes it was 33.3%, and for 4 or more it was 13.8%. The OS rate of patients with 1 or 2 LNM sites was significantly better than that for patients with more than 2 LNM sites. The OS rate of patients with adenocarcinoma (Ad) (28.6%) was significantly lower than that for patients with other histologic subtypes (squamous cell carcinoma; 66.7%, adenosquamous carcinoma; 75.0%, p = 0.0003). Multivariate analysis revealed that >2 LNM sites and Ad were independent prognostic factors for survival. The 5-year OS rate of patients with 1 or 2 LNM sites was 86.8%, a more favorable prognosis than the OS rates in other reports.


More than two LNM sites and adenocarcinoma were independent prognostic factors for node-positive patients with cervical cancer.


Cervical cancer Prognostic factor Number of pelvic lymph node metastasis sites 



We thank our colleagues (Department of Gynecology, Hokkaido University Graduate School of Medicine) for their assistance with the collection and analysis data.

Conflict of interest

No author has any conflict of interest.


  1. 1.
    Kodama J, Seki N, Ojima Y et al (2006) Prognostic factors in node-positive patients with Stage IB–IIB cervical cancer treated by radical hysterectomy and pelvic lymphadenectomy. Int J Gynaecol Obstet 93:130–135Google Scholar
  2. 2.
    Takeda N, Sakuragi N, Takeda M et al (2002) Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Acta Obstet Gynecol Scand 81:1144–1151PubMedGoogle Scholar
  3. 3.
    Trattner M, Graf AH, Lax S et al (2001) Prognostic factors in surgically treated Stage Ib–IIb cervical carcinomas with special emphasis on the importance of tumor volume. Gynecol Oncol 82:11–16Google Scholar
  4. 4.
    Burghardt E, Pickel H, Haas J et al (1987) Prognostic factors and operative treatment of Stages IB to IIB cervical cancer. Am J Obstet Gynecol 156:988–996Google Scholar
  5. 5.
    Chatani M, Nose T, Masaki N et al (1998) Adjuvant radiotherapy after radical hysterectomy of the cervical cancer. Prognostic factors and complications. Strahlenther Onkol 174:504–509CrossRefPubMedGoogle Scholar
  6. 6.
    Uno T, Isobe K, Yamamoto S et al (2006) Postoperative radiation therapy for carcinoma of the uterine cervix. Radiat Med 24:91–97CrossRefPubMedGoogle Scholar
  7. 7.
    Inoue T, Morita K (1990) The prognostic significance of number of positive nodes in cervical carcinoma Stages IB, IIA, and IIB. Cancer 65:1923–1927Google Scholar
  8. 8.
    Tsai CS, Lai CH, Wang CC et al (1999) The prognostic factors for patients with early cervical cancer treated by radical hysterectomy and postoperative radiotherapy. Gynecol Oncol 75:328–333CrossRefPubMedGoogle Scholar
  9. 9.
    Sakuragi N, Todo Y, Kudo M et al (2005) A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function. Int J Gynecol Cancer 15:389–397CrossRefPubMedGoogle Scholar
  10. 10.
    Piver MS, Rutledge F, Smith JP (1974) Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 44:265–272PubMedGoogle Scholar
  11. 11.
    Ramirez PT, Slomovitz BM, Soliman PT et al (2006) Total laparoscopic radical hysterectomy and lymphadenectomy: the M.D. Anderson Cancer Center experience. Gynecol Oncol 102:252–255Google Scholar
  12. 12.
    Pieterse QD, Kenter GG, Gaarenstroom KN et al (2007) The number of pelvic lymph nodes in the quality control and prognosis of radical hysterectomy for the treatment of cervical cancer. Eur J Surg Oncol 33:216–221CrossRefPubMedGoogle Scholar
  13. 13.
    Kenter GG, Hellebrekers BW, Zwinderman KH et al (2000) The case for completing the lymphadenectomy when positive lymph nodes are found during radical hysterectomy for cervical carcinoma. Acta Obstet Gynecol Scand 79:72–76CrossRefPubMedGoogle Scholar
  14. 14.
    Wydra D, Sawicki S, Wojtylak S (2006) Sentinel node identification in cervical cancer patients undergoing transperitoneal radical hysterectomy: a study of 100 cases. Int J Gynecol Cancer 16:649–654CrossRefPubMedGoogle Scholar
  15. 15.
    Daraï E, Lavoué V, Rouzier R et al (2007) Contribution of the sentinel node procedure to tailoring the radicality of hysterectomy for cervical cancer. Gynecol Oncol 106:251–256CrossRefPubMedGoogle Scholar
  16. 16.
    Marchiolè P, Buénerd A, Scoazec JY et al (2004) Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma. Cancer 100:2154–2159CrossRefPubMedGoogle Scholar
  17. 17.
    Lentz SE, Muderspach LI, Felix JC et al (2004) Identification of micrometastases in histologically negative lymph nodes of early-stage cervical cancer patients. Obstet Gynecol 103:1204–1210CrossRefPubMedGoogle Scholar
  18. 18.
    Ryu HS, Chun M, Chang KH et al (2005) Postoperative adjuvant concurrent chemoradiotherapy improves survival rates for high-risk, early stage cervical cancer patients. Gynecol Oncol 96:490–495CrossRefPubMedGoogle Scholar
  19. 19.
    Peters WA 3rd, Liu PY, Barrett RJ 2nd et al (2000) Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 18:1606–1613PubMedGoogle Scholar
  20. 20.
    Berek JS, Hacker NF, Fu YS et al (1985) Adenocarcinoma of the uterine cervix: histologic variables associated with lymph node metastasis and survival. Obstet Gynecol 65:46–52PubMedGoogle Scholar
  21. 21.
    Irie T, Kigawa J, Minagawa Y et al (2000) Prognosis and clinicopathological characteristics of Ib–IIb adenocarcinoma of the uterine cervix in patients who have had radical hysterectomy. Eur J Surg Oncol 26:464–467CrossRefPubMedGoogle Scholar
  22. 22.
    Kim SM, Choi HS, Byun JS (2000) Overall 5-year survival rate and prognostic factors in patients with Stage IB and IIA cervical cancer treated by radical hysterectomy and pelvic lymph node dissection. Int J Gynecol Cancer 10:305–312Google Scholar
  23. 23.
    Cheng X, Cai S, Li Z et al (2004) The prognosis of women with Stage IB1–IIB node-positive cervical carcinoma after radical surgery. World J Surg Oncol 2:47Google Scholar
  24. 24.
    Watari H, Ohta Y, Hassan MK et al (2008) Clusterin expression predicts survival of invasive cervical cancer patients treated with radical hysterectomy and systematic lymphadenectomy. Gynecol Oncol 108:527–532CrossRefPubMedGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2010

Authors and Affiliations

  • Masayoshi Hosaka
    • 1
  • Hidemichi Watari
    • 1
  • Takashi Mitamura
    • 1
  • Yousuke Konno
    • 1
  • Tetsuji Odagiri
    • 1
  • Tatsuya Kato
    • 1
  • Mahito Takeda
    • 1
  • Noriaki Sakuragi
    • 1
  1. 1.Department of GynecologyHokkaido University Graduate School of MedicineSapporoJapan

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