Predictive Factors of Pelvic Lymph Node Metastasis in Early-Stage Cervical Cancer

Abstract

Background: Pelvic lymphadenectomy, which is the routine surgical treatment for early-stage cervical cancer, causes serious morbidity. The goal of the current retrospective study was to identify predictive factors of lymph node metastasis (LNM) in patients with early-stage cervical cancer.

Patients and methods: The study included 496 patients diagnosed with stages IA2-IB1cervical cancer who underwent a radical hysterectomy with pelvic lymphadenectomy. The predictive factors of LNM were evaluated.

Results: The incidence of LNM in this study was 4.6%. LNM was more common in patients with deep stromal invasion (DSI), tumor size > 2 cm, lymph vascular invasion and parametrial involvement (PI). Multivariate analysis showed DSI (p = 0.010) and PI (p = 0.005) were independently associated with LNM. The median follow-up time was 56.9 months. The patients with LNM had poorer 5-year overall survival (77.8%; 95% confidence interval (CI) 44.2-92.6) than the patients without LNM (98.2%; 95% CI 95.6-99.2; p = 0.002) and also poorer 5-year recurrence-free survival (65.5%; 95% CI 38.6-82.8) than the patients without LNM (90.2%; 95% CI 86.5-92.9; p < 0.001).

Conclusion: The predictive factors of pelvic lymph node metastasis in stage IA2-IB1 cervical cancer patients were DSI and PI. LNM was associated with poorer oncological outcomes.

Keywords: Cervical cancer; Hysterectomy; Lymph node dissection; Lymph node metastasis; Prognosis; Risk factors.