Prediction of Metastatic Pelvic Lymph Node Diameter For Para-aortic Lymph Node Metastasis in Patients With Locally Advanced Cervical Cancer

Öz

Objectives: Investigation of the prediction of para-aortic lymph node (LN) metastasis by metastatic pelvic lymph node diameter in patients with locally advanced cervical cancer. Methods: Between 28 December 2010 and 30 March 2021, 57 patients with locally advanced cervical cancer [2B-4A 2018 FIGO] at Selcuk University's Faculty of Medicine were enrolled in this retrospective analysis. The involvement of pelvic and para-aortic LN in patients with surgical staging and outcomes were assessed. Results: The average age of 57 patients was 56 [33-78] years. Of patients, 73.7% were stage 2b, 12.3% were stage 3 and 14.0% were stage 4a. Of samples, 91.2% had histological type squamous cells. The mean number of LNs collected was 4 [0-49] and 10 [7-37] in patients with pelvic and para-aortic LN involvement, respectively. Para-aortic LN was positive in 9 patients and negative in 48 patients according to ROC analysis. Para-aortic LN involvement was predicted by metastatic pelvic LN cut-off diameter of 0.75 cm with 100% sensitivity and 89.6% specificity [AUC=0.959, p=0.001 [95% CI, 0.912-1.000]. Conclusion: The cut-off for pelvic LN dissection and metastatic pelvic LN diameter in locally advanced cervical cancer was accepted as 0.75 cm for predicting para-aortic LN involvement.

Anahtar Kelimeler

• cervical cancer
• lenf node diameter
• prediction
• surgery

Destekleyen Kurum

none

Etik Beyan

Necessary ethical approvals have been obtained

Teşekkür

No conflict of interest

Lokal İleri Evre Serviks Kanserinde Metastatik Pelvik Lenf Nodu Çapının Paraaortik Lenf Nodu Metastazına Yönelik Tahmini

Öz

Amaç: Lokal ileri servikal kanserli hastalarda metastatik pelvik lenf nodu çapına göre para-aortik lenf nodu [LN] metastazının tahmininin araştırılması. Gereç ve Yöntemler: 28 Aralık 2010 ile 30 Mart 2021 tarihleri arasında Selçuk Üniversitesi Tıp Fakültesi'nde lokal olarak ilerlemiş servikal kanserli 57 hasta [2B-4A 2018 FIGO] bu retrospektif analize dahil edildi. Cerrahi evreleme ve sonuçları olan hastalarda pelvik ve para-aortik LN tutulumu değerlendirildi. Bulgular: 57 hastanın ortalama yaşı 56 [33-78] yıldı. Hastaların %73,7'si evre 2b, %12,3'ü evre 3 ve %14,0'ı evre 4a idi. Örneklerin %91,2'sinde histolojik tip skuamöz hücreler vardı. Pelvik ve para-aortik LN tutulumu olan hastalarda toplanan ortalama LN sayısı sırasıyla 4 [0-49] ve 10 [7-37] idi. ROC analizine göre para-aortik LN 9 hastada pozitif, 48 hastada negatifti. Para-aortik LN tutulumu %100 duyarlılık ve %89,6 özgüllük ile 0,75 cm'lik metastatik pelvik LN kesme çapı ile tahmin edildi [AUC=0,959, p=0,001 [95% CI, 0,912-1,000]. Sonuç: Lokal ileri servikal kanserde pelvik LN diseksiyonu ve metastatik pelvik LN çapı için kesme değeri, para-aortik LN tutulumunu tahmin etmek için 0,75 cm olarak kabul edildi.

Anahtar Kelimeler

• serviks kanseri
• lenf nodu çapı
• öngörü
• cerrahi

Destekleyen Kurum

Yok

Etik Beyan

Gerekli etik onayı alındı

Teşekkür

Yok

Kaynakça

1. 1. Siegel RL MK, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020 Jan;70[1]:7-30.
2. 2. Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ et al. SEER Cancer Statistics Review, 1975-2004, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2004/, based on November 2006 SEER data submission, posted to the SEER web site, 2007.
3. 3. Bhatla, N., Aoki, D., Sharma, D. N., & Sankarana- rayanan, R. (2018). Cancer of the cervix uteri. In- ternational journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 143 Suppl 2, 22–36.
4. 4. Chantalat E, Vidal F, Leguevaque P, et al. Cervical cancer with paraaortic involvement: do patients truly benefit from tailored chemoradiation therapy?A retrospective study on 8 French centers. Eur J Obstet Gynecol Reprod Biol. 2015;193:118-122.
5. 5. Leblanc E, Narducci F, Frumovitz M, et al. Therapeu- tic value of pretherapeutic extraperitoneal laparo- scopic staging of locally advanced cervical carcino- ma. Gynecol Oncol. 2007;105(2):304-311.
6. 6. Lee WH, Kim GE, Kim YB. Prognostic factors of dose-response relationship for nodal control in metastatic lymph nodes of cervical cancer patients undergoing definitive radiotherapy with concurrent chemotherapy. J Gynecol Oncol. 2022;33(5):e59.
7. 7. Lee WH, Kim GE, Kim YB. Prognostic factors of dose-response relationship for nodal control in metastatic lymph nodes of cervical cancer patients undergoing definitive radiotherapy with concurrent chemotherapy. J Gynecol Oncol. 2022;33(5):e59.
8. 8. Benito V, Carballo S, Silva P, et al. Should the Pres- ence of Metastatic Para-Aortic Lymph Nodes in Locally Advanced Cervical Cancer Lead to More Aggressive Treatment Strategies?. J Minim Invasive Gynecol. 2017;24(4):609-616.

9. 9. Tsunoda AT, Marnitz S, Soares Nunes J, et al. Inci- dence of Histologically Proven Pelvic and Para-Aor- tic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial. Oncolo- gy. 2017;92(4):213-220.
10. 10. Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. Lancet. 2019;393(10167):169-182.
11. 11. Matsuo K, Grubbs BH, Mikami M. Quality and quantity metrics of pelvic lymph node metastasis and risk of para-aortic lymph node metastasis in stpelvic IB-IIB cervical cancer. J Gynecol Oncol. 2018;29(1):e10.
12. 12. De Cuypere M, Lovinfosse P, Goffin F, et al. Add- ed value of para-aortic surgical staging compared to 18F-FDG PET/CT on the external beam radiation field for patients with locally advanced cervical cancer: An ONCO-GF study. Eur J Surg Oncol. 2020;46(5):883-887.
13. 13. Gouy S, Seebacher V, Chargari C, et al. False negati- ve rate at 18F-FDG PET/CT in para-aortic lymphnode involvement in patients with locally advanced cervi- cal cancer: impact of PET technology. BMC Cancer.
14. 14. Frumovitz M, Querleu D, Gil-Moreno A, et al. Lymphadenectomy in locally advanced cervical can- cer study (LiLACS): Phase III clinical trial comparing surgical with radiologic staging in patients with stag- es IB2-IVA cervical cancer. J Minim Invasive Gynecol. 2014;21(1):3-8.
15. 15. Berek JS, Hacker NF. Practical gynecologic oncology. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2004, 908.
16. 16. Bhatla N, Berek JS, Cuello Fredes M, et al. Revised FIGO staging for carcinoma of the cervix uteri [pub- lished correction appears in Int J Gynaecol Obstet. 2019 Nov;147(2):279-280.
17. 17. Léonard B, Kridelka F, Delbecque K, et al. A clin- ical and pathological overview of vulvar con- dyloma acuminatum, intraepithelial neoplasia, and squamous cell carcinoma. Biomed Res Int. 2014;2014:480573.
18. 18. Bats AS, Mathevet P, Buenerd A, et al. The sentinel node technique detects unexpected drainage path- ways and allows nodal ultrastaging in early cervical cancer: insights from the multicenter prospective SENTICOL study. Ann Surg Oncol. 2013;20(2):413- 422.
19. 19. Sakuragi N, Satoh C, Takeda N, et al. Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterec- tomy. Cancer. 1999;85(7):1547-1554.
20. 20. Ayhan A, Aslan K, Öz M, Tohma YA, Kuşçu E, Mey- danli MM. Para-aortic lymph node involvement revisited in the light of the revised 2018 FIGO stag- ing system for cervical cancer. Arch Gynecol Obstet. 2019;300(3):675-682.
21. 21. Huang H, Liu J, Li Y, et al. Metastasis to deep ob- turator and para-aortic lymph nodes in 649 pa- tients with cervical carcinoma. Eur J Surg Oncol. 2011;37(11):978-983.
22. 22. Tsuruga T, Fujimoto A, Kawana K, et al. Radical hysterectomy with or without para-aortic lymph- adenectomy for patients with stage IB2, IIA2, and IIB cervical cancer: outcomes for a series of 308 patients. Int J Clin Oncol. 2016;21(2):359-366.
23. 23. Leblanc E, Gauthier H, Querleu D, et al. Accuracy of 18-fluoro-2-deoxy-D-glucose positron emission tomography in the pretherapeutic detection of oc- cult para-aortic node involvement in patients with a locally advanced cervical carcinoma. Ann Surg On- col. 2011;18(8):2302-2309
24. 24. Benedetti-Panici P, Maneschi F, Scambia G, et al. Lymphatic spread of cervical cancer: an anatomical and pathological study based on 225 radical hyster- ectomies with systematic pelvic and aortic lymph- adenectomy. Gynecol Oncol. 1996;62(1):19-24
25. 25. Belhocine T, Thille A, Fridman V, et al. Contribu- tion of whole-body 18FDG PET imaging in the management of cervical cancer. Gynecol Oncol. 2002;87(1):90-97.
26. 26. Belhocine T, Thille A, Fridman V, et al. Contribu- tion of whole-body 18FDG PET imaging in the management of cervical cancer. Gynecol Oncol. 2002;87(1):90-97