Region-specific Risk Factors for Pelvic Lymph Node Metastasis in Patients with Stage IB1 Cervical Cancer

Abstract

Objectives: We aimed to identify the risk factors associated with pelvic lymph node metastasis (LNM) at each anatomic location in patients with stage IB1 cervical cancer. Methods: A primary cohort of 728 patients with stage IB1 cervical cancer who underwent radical hysterectomy and systematic pelvic lymphadenectomy were retrospectively studied. All removed pelvic nodes (N=20,134) were pathologically examined. The risk factors for LNM in different anatomic regions (obturator, internal iliac, external iliac, and common iliac) were evaluated by multivariate logistic regression analyses. Nomograms were generated from the primary cohort and validated in another external cohort (N=242). The performance of the nomogram was assessed by its calibration and discrimination. Overall survival and progression-free survival in patients with different LNM patterns were compared. Results: LNM was found in 266 (1.3%) removed nodes and 106 (14.6%) patients. The incidences of LNM at the obturator, internal iliac, external iliac, common iliac, and parametrial regions were 8.5%, 5.4%, 4.7%, 1.9% and 1.8%, respectively. Among others, tumour size and lymph-vascular space invasion (LVSI), which are preoperatively assessable, were identified as independent risk factors of LNM in the common iliac region and the lower pelvis, respectively, and age was an additional independent risk factor of obturator LNM. The negative predictive values of tumour size <2 cm for common iliac LNM and negative LVSI combined with older age (> 50 years) for obturator LNM were 100% and 98.7%, respectively. A nomogram of these two factors showed good calibration and discrimination (concordance index, 0.761 in the primary cohort and 0.830 in validation cohort). The patients with common iliac LNM had poorer survival than those with LNM confined to the lower pelvis, while the differences in survival between patients with LNM confined to one node, one region or single side and those with more widely spreading LNM were not statistically significant. Conclusions: Tumour size, LVSI and age are region-specific risk factors for pelvic LNM in IB1 cervical cancer, which could be used to allocate the appropriate extent of pelvic lymphadenectomy.

FABP4 is an independent risk factor for lymph node metastasis and poor prognosis in patients with cervical cancer

“…Our previous study found that 14.6% of patients with early-stage CCa had LNM before surgery [ 11 ]. However, traditional imaging techniques are not sufficiently reliable to detect LNM (in a meta-analysis, the pooled sensitivity was 0.57 for computed tomography, 0.66 for positron emission tomography and 0.54 for magnetic resonance imaging) [ 12 ].…”

Can Conization Specimens Predict Sentinel Lymph Node Status in Early-Stage Cervical Cancer? A SENTICOL Group Study

“…Several studies have well established risk factors for node involvement, such as tumor size larger than 20 mm, the presence of lymphovascular space invasion (LVSI), deeper stromal invasion and parametrial involvement [ 8 , 9 , 10 , 11 , 12 ]. Nonetheless, results of these studies are based on final pathologic examination of radical hysterectomy specimens and are usually extrapolated for preoperative risk assessment.…”

Data from small cell neuroendocrine carcinoma of the cervix: FIGO 2018 staging is more accurate than FIGO 2009

“…In addition, prognosis differed in patients with different LNM locations or numbers (LNM involving the common iliac region vs lower regions, ≥3 vs 1–2, respectively). 24 , 26 Therefore, as in our study, it is reasonable to refine stage IIIc into subgroups according to the LNM degree and location.…”