Cancer Management and Research (Jan 2022)

Combination of Estrogen Receptor Alpha and Histological Type Helps to Predict Lymph Node Metastasis in Patients with Stage IA2 to IIA2 Cervical Cancer

  • Ke Y,
  • Zu S,
  • Chen L,
  • Liu M,
  • Yang H,
  • Wang F,
  • Zheng H,
  • He F

Journal volume & issue
Vol. Volume 14
pp. 317 – 325

Abstract

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Yumin Ke,1,* Shuiling Zu,2,* Lijun Chen,3,* Meizhi Liu,4 Haijun Yang,5 Fuqiang Wang,5 Huanhuan Zheng,6 Fangjie He7,8 1Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, People’s Republic of China; 2Nursing Department, The Third Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350100, People’s Republic of China; 3Department of Gynecological Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, People’s Republic of China; 4Department of Gynecology, The Third Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350100, People’s Republic of China; 5Department of Pathology, The Anyang Tumor Hospital, Anyang, 455000, People’s Republic of China; 6Department of Endocrinology, Ji’an Central People’s Hospital, Ji’an, 343000, People’s Republic of China; 7Department of Obstetrics and Gynecology, The First People’s Hospital of Foshan, Foshan, 528000, People’s Republic of China; 8State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People’s Republic of China*These authors contributed equally to this workCorrespondence: Fangjie HeDepartment of Obstetrics and Gynecology, The First People’s Hospital of Foshan, Foshan, People’s Republic of China; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People’s Republic of China, Tel +86-18038864533, Fax +86 757-83162610, Email [email protected]; [email protected]: This study aimed to identify a subset of patients with stage IA2 to IIA2 cervical cancer who are at low risk of lymph node metastasis (LNM) using pathological parameters including estrogen receptor alpha (ERα) and progesterone receptor (PR).Methods: The clinical data of patients with stage IA2 to IIA2 cervical cancer who underwent radical surgery between 2014 and 2015 were retrospectively reviewed. Immunohistochemical staining was used to determine the expression of ERα and PR. A low-risk criterion for LNM was identified using logistic regression analysis, and its performance was estimated through receiver-operating characteristic curve analysis.Results: Of 263 patients, 57 (21.7%) had pathological LNM. ERα (adjusted odds ratio [aOR], 7.582; 95% confidence interval [CI], 2.991– 19.222; P < 0.001) and squamous cell carcinoma (aOR, 3.520; 95% CI, 1.887– 6.568; P < 0.001) were identified as independent predictors for no LNM by multivariate logistic regression analysis, while PR had no effect on LNM. The rate of LNM was 1.4% for low-risk patients (n = 73) identified as ERα positive with squamous cell carcinoma. The 5-year disease-free survival in low-risk patients was significantly greater than in those negative for ERα and/or those with non-squamous cell carcinoma (96.9% vs 80.1%, P = 0.002).Conclusion: ERα positivity and squamous cell carcinoma are associated with a low risk of LNM in patients with stage IA2 to IIA2 cervical cancer. Hence, those patients without a low risk of LNM could be considered for definitive chemoradiotherapy to avoid unnecessary surgery.Keywords: cervical cancer, lymph node, estrogen receptor alpha, progesterone receptor, squamous cell carcinoma

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