Combining the negative lymph nodes count with the ratio of positive and removed lymph nodes can better predict the postoperative survival in cervical cancer patients

The positive and negative lymph node counts were calculated for 609 postoperative cervical cancer patients. The 5-year survival rate (5-YSR) was examined according to clinicopathologic variables. Cox regression was used to identify independent prognostic factors.The NLNs count cutoffs were determined to be 10 and 25 with 5-YSR of 62.8% and 80.5%. The RPL of 13 patients who had the NLNs count of 10 or fewer was >20%. Among 242 patients who had 10？<？NLNs count？≤？25, 194 without positive nodes had the 5-YSR of 77.8%, 31 with 0%？<？RPL？≤？5% had the 5-YSR of 3.2%, 15 with RPL？>？20% had died when follow-up was completed. Among 354 patients who had NLNs count >25, 185 without positive nodes had the 5-YSR of 87.6%, 6 with 0%？<？RPL？≤？5% had the 5-YSR of 25%, 15 with 5%？<？RPL？≤？20% had the 5-YSR of 4.5%, and 2 with RPL >20% had died when follow-up was completed. Furthermore, stage, histologic grade and RPL were independently correlated with overall survival of cervical cancer patients after RHPL in the multivariate analysis.RPL was an independent prognostic factor. The NLNs count is a key factor for improvement of survival prediction of RPL in cervical cancer.Cervical cancer is the third most common cancer and the fourth leading cause of cancer death in women worldwide, especially in developing countries [1]. Radical hysterectomy and pelvic lymphadenectomy (RHPL) are the standard treatment for FIGO (Federation International of Gynecology and Obstetrics) Stage IA2 to IIA2 cervical cancer, though nodal status does not affect the staging of cervical cancer [2]. The status of pelvic lymph node metastasis is one of the most important prognostic factors [3]. Masayoshi et al. reported the 5-year survival rate (5-YSR) of node-positive cervical cancer patients was 62.0%, which was significantly worse than that of node-negative patients (94.8%) [4].Nevertheless, whether the more optimal prognosis can be achieved by increasing the number of dissected lymph nodes is still disputable. Some