e17013 Background: The aim of this retrospective analysis is to evaluate the prognostic role of lymph node density (LND), i.e. the ratio of positive lymph nodes to the total number of lymph nodes removed during surgery, in nodal-positive cervical cancer patients. Methods: Out of 266 patients with cervical cancer that underwent surgery including lymphonodectomy between 2000 and 2017 at the Department for Gynecology and Obstetrics of the University Hospital Ulm, 86 patients with positive lymph nodes were included in the analysis. According to former study results, patients were divided into two groups with LND < 10% vs. ≥ 10%. Univariable and multivariable cox-regression models (adjusted for age, histological subtype, grading, body mass index, R-status, lymphangiosis, histologically confirmed FIGO-status and chemotherapy) were used to evaluate the association between LND and both overall survival (OS) and disease-free survival (DFS). Results: In the 86 patients, a median of 42 lymph nodes were removed (range 11 – 107), and a median of 2 lymph nodes (range 1 – 25) were found positive. 57 (66.3%) patients had a LND < 10% and 29 (33.7%) patients had a LND ≥ 10%. There was no significant association between LND (≥ 10% vs. < 10%) and OS in both univariable (hazard ratio[HR] 1.49, 95% CI 0.72 – 3.07, p = 0.280) and multivariable survival analysis (HR 1.46, 95% CI 0.64 – 3.32, p = 0.372), respectively. However, LND was significantly associated with DFS in univariable analysis (HR 2.11, 95% CI 1.10 – 4.03, p = 0.024) and was found to be an independent predictor for DFS in adjusted multivariable analysis (HR 2.30, 95% CI 1.08 – 4.91, p = 0.031). Conclusions: LND ≥ 10% in patients with lymph node-positive cervical cancer is associated with a worsened DFS compared to patients with a LND < 10%. Thus, LND may be used as an independent prognostic marker and/or for risk stratification in these patients.
