Distribution Pattern of Circumflex Iliac Node Distal to the External Iliac Node Metastasis in Stage IA to IIA Cervical Carcinoma

Yin, Yongkai; Li, Huiqin; Sheng, Xiugui; Li, Xinglan; Wang, Xiang

doi:10.1097/igc.0000000000000138

Cited by 9 publications

(4 citation statements)

References 20 publications

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“…For cervical cancer patients, lymph nodes status is a critical predictor of survival that has been applied to guide clinical treatment ( 16 ). The risk of lymph node metastasis increases per FIGO stage (2009 version), with incidences from 2% (stage IA2) to 14–36% (IB), 38–51% (IIA), and 47% (IIB) in the pelvic region; and from 2% to 5% (stage IB), 10–20% (IIA), 9% (IIB), 13–30% (III), and 50% (IV) in the paraaortic region ( 17 , 18 ). Once cervical cancer with lymph node metastasis occurs, the survival rate of patients is greatly reduced.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of Novel Nomograms to Predict the Overall Survival and Cancer-Specific Survival of Cervical Cancer Patients With Lymph Node Metastasis

Liu

Wang³

et al. 2022

Front. Oncol.

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ObjectiveThe objective of this study was to establish and validate novel individualized nomograms for predicting the overall survival (OS) and cancer-specific survival (CSS) in cervical cancer patients with lymph node metastasis.MethodsA total of 2,956 cervical cancer patients diagnosed with lymph node metastasis (American Joint Committee on Cancer, AJCC N stage=N1) between 2000 and 2018 were included in this study. Univariate and multivariate Cox regression models were applied to identify independent prognostic predictors, and the nomograms were established to predict the OS and CSS. The concordance index (C-index), calibration curves, and receiver operating characteristic (ROC) curves were applied to estimate the precision and discriminability of the nomograms. Decision-curve analysis (DCA) was used to assess the clinical utility of the nomograms.ResultsTumor size, log odds of positive lymph nodes (LODDS), radiotherapy, surgery, T stage, histology, and grade resulted as significant independent predictors both for OS and CSS. The C-index value of the prognostic nomogram for predicting OS was 0.788 (95% CI, 0.762–0.814) and 0.777 (95% CI, 0.758–0.796) in the training and validation cohorts, respectively. Meanwhile, the C-index value of the prognostic nomogram for predicting CSS was 0.792 (95% CI, 0.767–0.817) and 0.781 (95% CI, 0.764–0.798) in the training and validation cohorts, respectively. The calibration curves for the nomograms revealed gratifying consistency between predictions and actual observations for both 3- and 5-year OS and CSS. The 3- and 5-year area under the curves (AUCs) for the nomogram of OS and CSS ranged from 0.781 to 0.828. Finally, the DCA curves emerged as robust positive net benefits across a wide scale of threshold probabilities.ConclusionWe have successfully constructed nomograms that could predict 3- and 5-year OS and CSS of cervical cancer patients with lymph node metastasis and may assist clinicians in decision-making and personalized treatment planning.

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Section: Discussionmentioning

confidence: 99%

Development and Validation of Novel Nomograms to Predict the Overall Survival and Cancer-Specific Survival of Cervical Cancer Patients With Lymph Node Metastasis

Liu

Wang³

et al. 2022

Front. Oncol.

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“…This group of lymph nodes is usually included in CTV in previous studies [ 32 , 33 ], but seldom mentioned with specific contouring recommendations. Several reports, including our previous study [ 29 , 31 , 34 ], have described the incidence of the CINDEIN metastasis in cervical cancer from 2.5% to 8% and have demonstrated that CINDEIN is seldom involved in metastasis. In the present study, we found that 17 of 665 patients had CINDEIN involvement and the incidence of CINDEIN metastases was 2.6%.…”

Section: Discussionmentioning

confidence: 97%

Distribution pattern of lymph node metastases and its implication in individualized radiotherapeutic clinical target volume delineation of regional lymph nodes in patients with stage IA to IIA cervical cancer

Yin

Sheng

et al. 2015

Radiat Oncol

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BackgroundTo study the distribution pattern of lymph node metastases of stage IA to IIA cervical cancer and to clarify the individualized clinical target volume delineation of regional lymph nodes (CTVn).MethodsA total of 665 cases with International Federation Gynecology and Obstetrics stage IA to IIA cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively reviewed. The clinicopathological factors related to lymph node metastases were analyzed using logistic regression analysis.ResultsPelvic lymph node metastases were found in 168 of 665 patients resulting in a metastasis rate of 25.3%. Binary logistic regression analysis showed that age, lymph vascular space involvement, and deep stromal invasion statistically influenced pelvic lymph node metastases (p = 0.017, < 0.001, < 0.001, respectively). Pathological morphology type, lymph node metastases of the obturator, the external iliac and internal iliac, and the para-aortic had a strong influence on lymph node metastases of the common iliac (p = 0.022, 0.003, < 0.001, 0.009, respectively). Tumor size and lymph node metastases of the common iliac were significantly related to lymph node metastases of the para-aortic (p = 0.045, < 0.001, respectively). Lymph node metastases of the obturator, the external iliac and internal iliac were strongly correlated to lymph node metastases of the circumflex iliac node distal to the external iliac node (CINDEIN; p = 0.027, 0.024, respectively).ConclusionsFactors related to lymph node metastases should be comprehensively considered to design and tailor CTVn for radiotherapy of cervical cancer. Selective regional irradiation including the correlated lymphatic drainage regions should be performed.

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“…Second, the metastatic rate of CINDEIN is low. Previous studies showed that the percentage of CINDEIN metastasis was 0% to 2.6% in patients with FIGO stage up to IIb [ 16 17 ], and 4.0% to 10.1% in patients with pN1 disease [ 5 7 17 ]. In our study, the percentage of CINDEIN metastasis was 1.9% in all patients and 3.4% in patients who underwent removal of CINDEIN.…”

Section: Discussionmentioning

confidence: 99%

“…Ninety percent of patients with CINDEIN metastasis had multiple lymph node metastases and 80% had positive parametrial involvement. Yin et al [ 17 ] showed that CINDEIN metastases were strongly correlated with metastases of the obturator, external iliac, and IIN [ 17 ]. They found that 94% of patients with CINDEIN metastasis were associated with multiple sites of pelvic lymph node metastases, which was compatible with our results.…”

Section: Discussionmentioning

confidence: 99%

Incidence of metastasis in circumflex iliac nodes distal to the external iliac nodes in cervical cancer

et al. 2016

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ObjectiveA causal relationship between removal of circumflex iliac nodes distal to the external iliac nodes (CINDEIN) and lower leg edema has been recently suggested. The aim of this study was to elucidate the incidence of CINDEIN metastasis in cervical cancer.MethodsA retrospective chart review was carried out for 531 patients with cervical cancer who underwent lymph node dissection between 1993 and 2014. CINDEIN metastasis was pathologically identified by microscopic investigation. After 2007, sentinel lymph node biopsy was performed selectively in patients with non-bulky cervical cancer. The sentinel node was identified using 99mTc-phytate and by scanning the pelvic cavity with a γ probe.ResultsTwo hundred and ninety-seven patients (55.9%) underwent CINDEIN dissection and 234 (44.1%) did not. The percentage of International Federation of Gynecology and Obstetrics stage IIb to IV (42.4% vs. 23.5%, p<0.001) was significantly higher in patients who underwent CINDEIN dissection than those who did not. CINDEIN metastasis was identified in 1.9% overall and in 3.4% of patients who underwent CINDEIN dissection. For patients with stage Ia to IIa disease, CINDEIN metastasis was identified in 0.6% overall and in 1.2% of patients who underwent CINDEIN dissection. Of 115 patients with sentinel node mapping, only one (0.9%) had CINDEIN detected as a sentinel node. In this case, the other three lymph nodes were concurrently detected as sentinel lymph nodes.ConclusionCINDEIN dissection can be eliminated in patients with stage Ia to IIa disease. CINDEIN might not be regional lymph nodes in cervical cancer.

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Distribution Pattern of Circumflex Iliac Node Distal to the External Iliac Node Metastasis in Stage IA to IIA Cervical Carcinoma

Abstract: Circumflex iliac node distal to the external iliac node metastases seemed to occur secondarily to widespread PLN metastases. In early stage cervical cancer, removal of the CINDEIN as a routine surgical procedure might be omitted to reduce operation time and minimize surgical morbidity.

Cited by 9 publications

References 20 publications

Development and Validation of Novel Nomograms to Predict the Overall Survival and Cancer-Specific Survival of Cervical Cancer Patients With Lymph Node Metastasis

Development and Validation of Novel Nomograms to Predict the Overall Survival and Cancer-Specific Survival of Cervical Cancer Patients With Lymph Node Metastasis

Distribution pattern of lymph node metastases and its implication in individualized radiotherapeutic clinical target volume delineation of regional lymph nodes in patients with stage IA to IIA cervical cancer

Incidence of metastasis in circumflex iliac nodes distal to the external iliac nodes in cervical cancer

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