Redefining stage IVB cervical cancer: The unique prognosis of distant lymph node metastasis which is comparable to stage IIIC.

Objective: Current staging systems classify distant lymph node metastasis (DLM) in cervical cancer as stage IVB, typically treated with systemic therapy. We aim to assess if patients with DLM have different survival rates than those with other stage IVB cervical cancer forms.

Methods: This study included patients diagnosed with metastatic cervical cancer from 2000 to 2021, divided into three groups: para-aortic lymph node metastasis (PaLM), DLM, and distant organ metastasis (DM). Kaplan-Meier analyses estimated cervical cancer-specific (CCSS) and overall survival (OS). A 1:1 propensity-score match between DLM and PaLM patients used logistic regression. Univariate and multivariate Cox analyses identified prognostic risk factors.

Results: Of the included 6241 patients, 2079 (33.3 %) were diagnosed with PaLM only, 631 (10.1 %) with DLM only, and 3531 (56.6 %) had DM. Multivariate Cox regression analysis indicated that patients with DLM exhibited comparable CCSS (HR, 0.91; P = 0.28) and OS (HR, 0.93; P = 0.34) to those with PaLM. In contrast, compared to patients with DM, the DLM cohort demonstrated significantly improved CCSS (HR, 0.54; P < 0.001) and OS (HR, 0.58; P < 0.001). Following matching, the CCSS (HR, 0.96; P = 0.70) and OS (HR, 0.95; P = 0.61) of patients with DLM remained comparable to those with PaLM. Among the 632 patients with DLM, locoregional treatments such as total hysterectomy (HR, 0.46; P = 0.039) and radiotherapy (HR, 0.34; P = 0.046) were independently associated with improved OS.

Conclusion: In cervical cancer, metastasis confined to distant lymph nodes indicates a locoregionally advanced stage, distinct from other stage IVB forms, and can be treated curatively with intensive locoregional therapy.