Risk stratification models for para-aortic lymph node metastasis and recurrence in stage IB–IIB cervical cancer

Abstract

ObjectiveTo examine the surgical-pathological predictors of para-aortic lymph node (PAN) metastasis at radical hysterectomy, and for PAN recurrence among women who did not undergo PAN dissection at radical hysterectomy.MethodsThis is a retrospective analysis of a nation-wide cohort study of surgically-treated stage IB–IIB cervical cancer (n=5,620). Multivariate models were used to identify independent surgical-pathological predictors for PAN metastasis/recurrence.ResultsThere were 120 (2.1%) cases of PAN metastasis at surgery with parametrial involvement (adjusted odds ratio [aOR]=1.65), deep stromal invasion (aOR=2.61), ovarian metastasis (aOR=3.10), and pelvic nodal metastasis (single-node aOR=5.39 and multiple-node aOR=33.5, respectively) being independent risk factors (all, p<0.05). Without any risk factors, the incidence of PAN metastasis was 0.9%, while women exhibiting certain risk factor patterns (>20% of the study population) had PAN metastasis incidences of ≥4%. Among 4,663 clinically PAN-negative cases at surgery, PAN recurrence was seen in 195 (4.2%) cases that was significantly higher than histologically PAN-negative cases (2.5%, p=0.046). In clinically PAN-negative cases, parametrial involvement (adjusted hazard ratio [aHR]=1.67), lympho-vascular space invasion (aHR=1.95), ovarian metastasis (aHR=2.60), and pelvic lymph node metastasis (single-node aHR=2.49 and multiple-node aHR=8.11, respectively) were independently associated with increased risk of PAN recurrence (all, p<0.05). Without any risk factors, 5-year PAN recurrence risk was 0.8%; however, women demonstrating certain risk factor patterns (>15% of the clinically PAN-negative population) had 5-year PAN recurrence risks being ≥8%.ConclusionSurgical-pathological risk factors proposed in this study will be useful to identify women with increased risk of PAN metastasis/recurrence.

Significance of Malignant Peritoneal Cytology on the Survival of Women with Early-Stage Cervical Cancer: A Japanese Gynecologic Oncology Group Study

“…The current study validates the results of prior studies in that the presence of malignant cells in pelvic cytology testing at the time of radical hysterectomy is associated with decreased survival in women with early-stage cervical cancer. As prior studies were limited in the sample size (range, 105-448) and the number of malignant peritoneal cytology cases (range, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], the findings from our study, which included a larger patient pool, are more reliable for interpretation of the analysis [6][7][8][9][10].…”

“…This is a secondary analysis of a prior nationwide multicenter retrospective study conducted in Japanese Gynecologic Oncology Group (JGOG)-designated institutions [18][19][20][21][22][23][24][25]. The study concept and participation call for this landmark collaborator study was initially announced to all JGOG-designated institutions (182 sites), and 116 (63.7%) of these sites voluntarily participated in this study (JGOG-1072S).…”

“…Detail of the utilized methodology was previously described [18][19][20][21][22][23][24][25]. Briefly, data collection took place at each study site by deploying a universal data entry form for the collection of clinical, tumor, treatment and survival information from archived medical records.…”

“…Cutoff and grouping for the clinico-pathological variables were based on previous studies [18][19][20][21][22][23][24][25]. Definition of hospital surgical volume was based on a prior study: <32 cases for low-volume, 32-104 cases for mid-volume, and ≥105 cases for high-volume over five years [21].…”

Stereotactic Radiotherapy for Oligometastases in Lymph Nodes—A Review

“… 10 , 11 Matsuo et al reported that PALN recurrence was seen in 195 (4.2%) cases among 4663 clinically PALN-negative cases at surgery in a retrospective analysis of a Japanese nationwide cohort study of surgically treated stage IB–IIB cervical cancer. 12 …”