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

Abstract

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.

New therapeutic approaches in the treatment of node-positive cervical cancer patients based on molecular targets: a systematic review

“…From both the functional and ontogenetic points of view, CC is seen to spread in a complex network in various directions, including into lymph vessels and nodes [18]. Furthermore, studies have confirmed that up to 25% of early CC cases result from primary sites of lymph node metastasis and also transport tumor cells into bone marrow [19,20]. These results form a prerequisite for improving our knowledge of the biological activity of the disease and its spreading mechanisms; in particular, it assists us to locate CC cells in the potentially "vulnerable therapeutic areas" of the lymph nodes and lymph vessels.…”

“…journals.viamedica.pl/ginekologia_polska in patients with higher-stage cancers. The clinical factors that influence the prognosis for invasive cervical squamous carcinoma, the most common CC subtype, are stage of disease, age of patient, depth of invasion, volume of tumor, and lymphatic or vascular invasion; all of which correlate with the risk of lymph node metastasis (LNM) and systemic spread [1,2].…”

Approaches to surgical staging of cancer of the uterine cervix

“…Вызывают много вопросов раз-розненные данные по частоте обнаруживаемых мета-стазов в лимфатических узлах при одинаковых стади-ях заболевания. Так, при стадии IIA метастатическое поражение лимфатических узлов составляет 10-27 %, а при стадии IB1 положительные лимфатические узлы находят в 5-17 % [35,36].…”

Intramuscular vaccination targeting mucosal tumor draining lymph node enhances integrins-mediated CD8+ T cell infiltration to control mucosal tumor growth

“…18,19 It has also been shown that IM administration of drugs or vaccines in the quadriceps muscles of the thigh leads to accumulation of the molecules and enhancement of immune responses in the inguinal LNs. 20,21 Since axillary and inguinal LNs have been identified as the draining LNs for oral and cervical cancers, respectively, [22][23][24] we hypothesize that selecting the IM vaccination sites that target the various mucosal tdLNs can lead to the generation of potent infiltrating antigen-specific CD8C T cell responses for the control of mucosal tumors.…”