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Abstract Background To identify the cut-off values for the number of metastatic lymph nodes (nMLN) and lymph node ratio (LNR) that can predict outcomes in patients with FIGO 2018 IIICp cervical cancer (CC). Methods Patients with CC who underwent radical hysterectomy with pelvic lymphadenectomy were identified for a propensity score-matched (PSM) cohort study. A receiver operating characteristic (ROC) curve analysis was performed to determine the critical nMLN and LNR values. Five-year overall survival (OS) and disease-free survival (DFS) rates were compared using Kaplan–Meier and Cox proportional hazard regression analyses. Results This study included 3,135 CC patients with stage FIGO 2018 IIICp from 47 Chinese hospitals between 2004 and 2018. Based on ROC curve analysis, the cut-off values for nMLN and LNR were 3.5 and 0.11, respectively. The final cohort consisted of nMLN ≤ 3 (n = 2,378) and nMLN > 3 (n = 757) groups and LNR ≤ 0.11 (n = 1,748) and LNR > 0.11 (n = 1,387) groups. Significant differences were found in survival between the nMLN ≤ 3 vs the nMLN > 3 (post-PSM, OS: 76.8% vs 67.9%, P = 0.003; hazard ratio [HR]: 1.411, 95% confidence interval [CI]: 1.108–1.798, P = 0.005; DFS: 65.5% vs 55.3%, P 0.11 (post-PSM, OS: 82.5% vs 76.9%, P = 0.010; HR: 1.407, 95% CI: 1.103–1.794, P = 0.006; DFS: 72.8% vs 65.1%, P = 0.002; HR: 1.347, 95% CI: 1.110–1.633, P = 0.002) groups. Conclusions This study found that nMLN > 3 and LNR > 0.11 were associated with poor prognosis in CC patients.

Background: To compare the oncological outcomes of Chinese patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC cervical cancer (CC) receiving radical chemoradiotherapy (R-CT), abdominal radical hysterectomy (ARH), or neoadjuvant chemotherapy and radical surgery (NACT). Methods: Overall, 4086 patients in 47 hospitals from 2004 to 2018 were divided into groups according to stage (4029 with stage IIIC1 and 57 with stage IIIC2). Kaplan-Meier and Cox regression analyses were applied to compare the 5-year overall survival (OS) and disease-free survival (DFS) of the three initial treatments before and after propensity score matching (PSM). Results: The 5-year DFS was worse in patients with stage IIIC2 than in those with stage IIIC1 (post-PSM: 68.3% vs. 39.9%, p < 0.001). For stage IIIC1, the ARH group had better 5-year OS (post-PSM: 71.0% vs. 80.0%, p < 0.001) and DFS (post-PSM: 67.2% vs. 71.0%, p < 0.001) than the R-CT group, while the NACT group had worse 5-year DFS (post-PSM: 67.7% vs. 55.3%, p = 0.002). The 5-year OS (post-PSM: 80.9% vs. 70.5%, p < 0.001) and DFS (post-PSM: 70.7% vs. 54.1%, p < 0.001) were better in the ARH than in the NACT group. For stage IIIC2, the 5-year DFS was better in the ARH than in the NACT group (45.4% vs. 30.1%, p = 0.025). Conclusions: The oncological prognosis of patients with stage IIIC1 CC was generally better than that of patients with stage IIIC2, thereby supporting the rationale behind the classification of stage IIIC. In less developed areas, the ARH is a promising alternative treatment option for patients with stage IIIC; nonetheless, the use of NACT is not advisable. Clinical Trial Registration: The study was registered at http://apps.who.int/trialsearch/, registration number CHiCTR1800017778.