Abstract
PURPOSE: To analyze the characteristics and survival of patients with mesorectum metastatic lymph nodes (MLNs) from cervical cancer. PATIENTS AND METHODS: We retrospectively reviewed 1194 consecutive patients with FIGO stage IA-IVA cervical cancer who were treated with definitive radiotherapy between January 2011 and December 2015 in our institute. Patients were treated with intensity-modulated radiation therapy (IMRT) and brachytherapy, combined with concurrent chemotherapy. Mesorectum, pelvic and para-aortic MLNs were boosted 59-61Gy with IMRT. We calculated the clinical characteristics and survival of the patients with and without mesorectum MLNs and made comparisons between them. RESULTS: The incidence rate of mesorectum MLNs was 0.8% (10/1194). The incidence rates for patients with FIGO stages I, II, III, and IVA disease were 0%, 0.4%, 2.0%, and 33.3%, respectively. Mesorectum MLNs were associated with more advanced stage (p <0.001); larger tumor size (p = 0.002), para-aortic MLNs (p <0.001), common iliac MLNs (p <0.001), and bilateral pelvic MLNs (p <0.001). All patients with mesorectum MLNs experienced treatment failure and died during follow-up. The median overall survival was 10.43 months. The 2-year overall survival (OS), disease-free survival (DFS), and local control (LC) rates were 10%, 0%, and 30%, respectively. Multivariate analysis showed that that mesorectum MLNs (hazard ratio, HR 4.0, 95% CI 1.8-9.1, p=0.001), para-aortic MLNs (HR 1.8, 95% CI 1.1-2.8, p=0.017) and pelvic MLNs (HR 2.5, 95% CI 1.7-3.7, p<0.001) were independent prognostic factors of OS. CONCLUSION: Mesorectum MLNs from cervical cancer are rare. And, the survival of patients with mesorectum MLNs was poor after dose-escalated concurrent chemoradiotherapy.