Abstract
BackgroundSystematic pelvic lymphadenectomy or whole pelvic irradiation is recommended for the patients with stage IB1 cervical cancer. However, the precise pattern of lymphatic tumor spread in cervical cancer is unknown. In the present study we evaluated the distribution of nodal metastases in stage IB1 cervical cancer to explore the possibilities for tailoring cancer treatment.MethodsA total of 289 patients with cervical cancer of stage IB1, according to FIGO 2009, were retrospectively analyzed. All patients underwent laparoscopic radical hysterectomy (Querleu and Morrow type C2) and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy (level 2 or level 3 according to Querleu and Morrow) from October 2014 to December 2017. Lymph nodes removed from 7 well-defined anatomical locations as well as other tissues were examined histopathologically, and typed, graded, and staged according to the WHO/IARC classification.ResultsTotally 8314 lymph nodes were analyzed with the average number of 31.88 ± 10.34 (Mean ± SD) lymph nodes per patient. Nodal metastases were present in 44 patients (15.22%). The incidence of lymphatic spread to different anatomic sites ranged from 0% (presacral) to 30.92% (obturator nodes). Tumor size above 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion were shown to be significantly correlated with the higher risk of lymphatic metastasis, while obesity (BMI ≥ 25) was independently negatively associated with lymphatic metastases.ConclusionsThe incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. Individual treatment could be considered for the selected low-risk patients who have smaller tumors and obesity and lack of the parametrial invasion or LVSI.
Highlights
Systematic pelvic lymphadenectomy or whole pelvic irradiation is recommended for the patients with stage IB1 cervical cancer
Full list of author information is available at the end of the article
In this study we retrospectively examined the nodal metastases of stage IB1 cervical cancer and evaluated diverse risk factors for it, in term of to provide new insights into the clinical decisions in personalized treatment of early cervical cancer
Summary
Systematic pelvic lymphadenectomy or whole pelvic irradiation is recommended for the patients with stage IB1 cervical cancer. The precise pattern of lymphatic tumor spread in cervical cancer is unknown. The incidence of lymph node metastasis in patients with stage IB1 cervical cancer has been reported to be 13–22% [1, 2]. Regardless of the low risk of lymph node metastasis, the whole pelvic chemoradiotherapy is often recommended [3, 4]. The precise pattern of lymphatic tumor spread of the early-stage cervical cancer is unknown. It is not clear how often lymph node metastases occur in different locations and which lymph nodes must be treated to completely cure all nodal metastatic deposits. More knowledge is required to set up a standard of a more patient oriented and risk-adapted treatment plan
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