Risk factors for lymph node involvement in early stage cervical cancer A retrospective cohort study

Abstract

One of the most important prognostic factors in cervical cancer is lymph node involvement that affects disease-free survival and plays an important role in the treatment. This study aimed to determine the factors affecting lymph node involvement in early stage cervical cancer. A total of 169 cervical cancer patients with stage IA2-IIA2 were enrolled. Age, histologic subtype, deep stromal invasion (DSI), largest tumor diameter (LTD), lymphovascular space invasion (LVSI), vaginal surgical margin, ovarian metastasis status, parametrial involvement, lymph node count and presence of metastasis were retrospectively reviewed. All of these parameters are divided into two groups: LNM positive (group 1) and negative (group 2). The median age of the patients was 52 (26-77) years. In the univariate regression analysis; LVSI (p <0.001), DSI (p=0.018), parametrial involvement (p = 0.001), and vaginal surgical margin positivity (p = 0.020) were in statistically significant correlations with lymph node involvement. In multivariate regression analysis, LVSI [51/118 (43.2%) vs 7/51 (13.7%), OR = 3.9, p = 0.003] and parametrial involvement [(16/24 (66.6%) vs 42/145 (28.9%), OR = 3.9, p = 0.009] were the independent risk factors for lymph node metastasis. LVSI and parametrial involvement are two crucial risk factors for lymph node metastasis in patients diagnosed with early-stage cervical cancer.

Keywords

• cervical cancer
• ; lymph-vascular space invasion
• lymph node metastasis

References

1. 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021:71:209–49.
2. 2. Guimarães YM, Godoy LR, Longatto-Filho A, Reis RD. Management of Early-Stage Cervical Cancer: A Literature Review. Cancers (Basel). 2022;14(3):575.
3. 3. Togami S, Kamio M, Yanazume S, Yoshinaga M, Douchi T. Can pelvic lymphadenectomy be omitted in stage IA2 to IIB uterine cervical cancer? J International Journal of Gynecologic Cancer. 2014;24(6):1072-6.
4. 4. Jiamset I, Hanprasertpong J. Risk Factors for Parametrial Involvement in Early-Stage Cervical Cancer and Identification of Patients Suitable for Less Radical Surgery. Oncology research and treatment. 2016;39(7-8):432–8.
5. 5. Cibula D, Pötter R, Planchamp F, Avall-Lundqvist E, Fischerova D, Haie Meder C, et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients With Cervical Cancer. Int J Gynecol Cancer. 2018;28(4):641-55.
6. 6. Colturato LF, Signorini Filho RC, Fernandes RC, Gebrim LH, Oliani AH. Lymph node micrometastases in initial stage cervical cancer and tumoral recurrence. Int J Gynaecol Obstet. 2016;133(1): 69-75.
7. 7. Panici PB, Basile S, Angioli R. Pelvic and aortic lymphadenectomy in cervical cancer: the standardization of surgical procedure and its clinical impact. J Gynecologic Oncology. 2009;113(2):284-90.
8. 8. Ditto A, Martinelli F, Lo Vullo S, Reato C, Solima E, Carcangiu M, et al. The role of lymphadenectomy in cervical cancer patients: the significance of the number and the status of lymph nodes removed in 526 cases treated in a single institution. Ann Surg Oncol. 2013;20(12): 3948-54.

9. 9. Klapdor R, Hertel H, Soergel P, Jentschke M, Hillemanns P. Application of sentinel lymph node dissection in gynecological cancers: results of a survey among German hospitals. Arch Gynecol Obstet. 2017;295(3):713-20.
10. 10. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105(2): 103-4.
11. 11. Yanaranop M, Sathapornteera N, Nakrangsee S. Risk factors of pelvic lymph node metastasis in cervical adenocarcinoma following radical hysterectomy and pelvic lymphadenectomy. J Med Assoc Thai. 2014;97 Suppl 11(Suppl 11): S87-S95.
12. 12. Zhou J, Ran J, He ZY, Quan S, Chen QH, Wu SG, et al. Tailoring Pelvic Lymphadenectomy for Patients with Stage IA2, IB1, and IIA1 Uterine Cervical Cancer. J Cancer. 2015;6(4): 377-81.
13. 13. Sun JR, Zhang YN, Sun XM, Feng SY, Yan M. Prediction model of pelvic lymph node metastasis in early stage cervical cancer and its clinical value. Minerva Chir. 2011;66(6):p. 537-45.
14. 14. Wang Y, Yao T, Yu J, Li J, Chen Q, Lin Z. Can pelvic lymphadenectomy be omitted in patients with stage IA2, IB1, and IIA1 squamous cell cervical cancer? Springerplus. 2016;5(1):1262.
15. 15. Yue C, Wang M, Ding B, Wang W, Fu S, Zhou D, et al. Polymorphism of the pre-miR-146a is associated with risk of cervical cancer in a Chinese population. Gynecol Oncol. 2011;122(1):33-7.
16. 16. Roman LD, Felix JC, Muderspach LI, Varkey T, Burnett AF, Qian D, et al. Influence of quantity of lymph-vascular space invasion on the risk of nodal metastases in women with early-stage squamous cancer of the cervix. Gynecol Oncol. 1998;68(3):220-5.
17. 17. Sakuragi N, Takeda N, Hareyama H, Fujimoto T, Todo Y, Okamoto K, et al. A multivariate analysis of blood vessel and lymph vessel invasion as predictors of ovarian and lymph node metastases in patients with cervical carcinoma. Cancer. 2000;88(11):2578-83.
18. 18. Hsu HC, Tai YJ, Chen YL, Chiang YC, Chen CA, Cheng WF. Factors predicting parametrial invasion in patients with early-stage cervical carcinomas. PLoS One. 2018;13(10):e0204950.