Do the pelvic lymph nodes predict the parametrial status in cervical cancer stages IB–IIA?

Abstract

The aim of this study was to determine whether the pelvic lymph nodes would predict the parametrial status in patients with cervical cancer stages IB1–IIA submitted to radical surgery and pelvic lymphadenectomy. To this end, we evaluated the relationship between positive and negative pelvic lymph nodes and their parametria. Our final purpose was to use this information to recommend the tailoring of the parametrial resection according to the status of pelvic lymph nodes to decrease the morbidity related with radical paratrectomy. From January 1996 to December 2001, 107 consecutive patients with cervical cancer stages IB1 and IIA were primarily treated by radical hysterectomy type III with systematic pelvic lymphadenectomy in a prospective study. Parametria were studied in two sections: the first included the tissue adjacent to the cervix, and the second the distal 2/3. Lymph nodes were routinary processed. Twenty-two patients (20.6%) had positive pelvic nodes and 16 patients (14.9%) had parametrial involvement, mostly by direct extension. Eight patients with positive pelvic nodes (36.4%) had parametrial involvement, whereas among 85 patients with negative pelvic nodes only eight patients (9.4%) had parametrial involvement (P < 0.001), most in internal parametria (62.5%). The sensitivity of pelvic lymph nodes for parametrial involvement was 50% and the positive predictive value was 36.4%, whereas the specificity was 84.6%; and the negative predictive value 90.6%. In the group of negative pelvic lymph nodes, only two patients (2.3%) had parametrial involvement beyond internal parametria. The univariated and multivariated analysis of prognostic factors was always significant but without a significant independent factor for positive parametria. Pelvic lymph nodes appear as good predictors of parametrial status, especially in node-negative patients, and could be used to decrease the paratrectomy in radical surgery.

Type II radical hysterectomy and adjuvant therapy for pelvic lymph node metastasis with stage IB–IIB cervical carcinoma: A retrospective study of 288 patients

“…Compared to the OS rate published in other studies (30–60%), this OS rate is higher 9, 10. A non‐SCC histological subtype, clinical stage, pre‐operative SCC‐Ag levels, tumor diameter, depth of cervical invasion, uterine corpus invasion, and parametrial involvement were also factors found to be significantly associated with cervical carcinoma PLNM ( P < 0.05), and this is consistent with previous reports 19–22. Furthermore, the identification of a non‐SCC histological subtype and parametrial involvement specifically as independent prognosis factors for patients with PLNM was also consistent with the results of previous studies 11–13, 20.…”

What is the risk for parametrial involvement in women with early‐stage cervical cancer with tumour <20 mm and with negative sentinel lymph nodes?

“…1 Radical hysterectomy and pelvic lymphadenectomy is the standard surgical treatment for early-stage cervical cancer. [5][6][7][8][9][10][11] Based on the literature data, the incidence of parametrial involvement in early-stage cervical cancer is 4-16.2% depending on tumour size, 5,6,9,12,13 and in the group of small-volume tumour up to 20 mm in largest diameter, parametrial involvement is rare. 2 The most common morbidity related to radical hysterectomy is blood loss and long-term urinary complications.…”

“…3,4 Several studies have been published which have tailored the radicality of surgery to the tumour size, presence of lymphovascular space invasion and negativity of the sentinel and pelvic lymph nodes. [5][6][7][8][9][10][11] Based on the literature data, the incidence of parametrial involvement in early-stage cervical cancer is 4-16.2% depending on tumour size, 5,6,9,12,13 and in the group of small-volume tumour up to 20 mm in largest diameter, parametrial involvement is rare. 7,10,11,[14][15][16] On the other hand, parametrial metastatic involvement is a strong predictive factor for recurrence of disease.…”

The Relationship Between Parametrial Involvement and Parametrial Tissue Removed in Radical Surgery in Early-Stage Cervical Cancer

“…Furthermore, 73% of the relapsed patients in the type 1 group and 75% of the patients in the type 3 group survived free of disease specific signs after salvage treatment [ 29 ]. Morbidities related to blood loss, urinary and bowel dysfunction were determined to be significantly lower in the type 1 hysterectomy group [ 29 , 32 ].…”

“…The incidence of PI in cases with positive lymph node metastasis varies between 36.4% and 48%, so the lymph node metastasis is accepted as one of the most critical risk factors predicting PI [ 32 , 33 ]. The incidence of parametrial involvement was reported 28% in the early-staged patients with positive sentinel lymph nodes [ 34 ].…”