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. 2017 Mar 8;8(31):51840-51847.
doi: 10.18632/oncotarget.16025. eCollection 2017 Aug 1.

Predictive factors of para-aortic lymph nodes metastasis in cervical cancer patients: a retrospective analysis based on 723 para-aortic lymphadenectomy cases

Xiaotian Han #  1   2 , Hao Wen #  1   2 , Xingzhu Ju  1   2 , Xiaojun Chen  1   2 , Guihao Ke  1   2 , Yuqi Zhou  1   2 , Jin Li  1   2 , Lingfang Xia  1   2 , Jia Tang  1   2 , Shanhui Liang  1   2 , Xiaohua Wu  1   2
Affiliations

Predictive factors of para-aortic lymph nodes metastasis in cervical cancer patients: a retrospective analysis based on 723 para-aortic lymphadenectomy cases

Xiaotian Han et al. Oncotarget. .

Abstract

Para-aortic lymph node (PALN) dissection is optional and controversial in patients with stage IB1-IIA2 cervical cancer. This retrospective study investigated PALN involvement patterns and evaluated preoperative clinical factors. A total of 723 consecutive FIGO stage IB1-IIA2 cervical cancer patients were included in the study. All patients underwent radical hysterectomy/radical trachelectomy, pelvic lymph node dissection, and PALN dissection. PALN metastasis was found in 101 (14.0%) patients, and the positive PALN rates of stage IB1, IB2, IIA1, and IIA2 were 8.4%, 11.1%, 17.2% and 21.7%, respectively. A multivariate model suggested age > 46 years (OR: 1.67, 95% confidence interval (CI): 1.08-2.58), tumor size > 3.5 cm (OR: 1.79, 95% CI: 1.12-2.87), and FIGO stage IIA (vs. IB) (OR: 1.97, 95% CI: 1.25-3.11) all positively correlated with PALN metastasis. When squamous cervical cancer cases were categorically analyzed, a multivariate model indicated age > 46 years (OR: 1.67, 95% CI: 1.00-2.80), FIGO stage IIA (vs. IB) (OR: 1.76, 95% CI: 1.02-3.02), and squamous cell carcinoma antigen (SCCA) > 6.5 ng/ml (OR: 5.20, 95% CI: 3.07-8.81) all positively correlated with PALN metastasis. Age, tumor size, and FIGO stage correlated with PALN metastasis in cervical cancer, while age, FIGO stage, and SCCA level were predictive in squamous cell carcinoma.

Keywords: SCCA; cervical cancer; lymphadenectomy; para-aortic lymph node; pelvic lymph node.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Kaplan-Meier curves of positive para-aortic lymph node (PALN) patients and negative PALN patients
Three-year survival rate of negative PALN patients was higher than that of positive PALN patients (89.5 ± 1.5% vs. 67.0 ± 6.0%, p < 0.001).
Figure 2
Figure 2. Flow chart of individual para-aortic lymphadenectomy in patients with stage IB1-IIA2 cervical cancer
PALN: para-aortic lymph node, PLN: pelvic lymph node (including obturator, external, internal, and common iliac lymph nodes), SCCA: squamous cell carcinoma antigen, SCC: squamous carcinoma.PALN dissection was recommended for patients under any one of the following situations: 1. suspicious PALN by intra-operative exploration/PET-CT/CT/MRI, 2. positive PLN diagnosed by pathology(e.g. frozen section, imprint smear). For the remaining patients, PALN dissection was recommended for those with FIGO stage = IIA, tumor size > 3.5 cm, age > 46y and SCCA > 6.5 ng/ml (in SCC).
See this image and copyright information in PMC

References

    1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108. - PubMed
    1. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–132. - PubMed
    1. Ditto A, Martinelli F, Lo Vullo S, Reato C, Solima E, Carcangiu M, Haeusler E, Mariani L, Lorusso D, Raspagliesi F. 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;20:3948–3954. - PubMed
    1. Gien LT, Covens A. Lymph node assessment in cervical cancer: prognostic and therapeutic implications. Journal of surgical oncology. 2009;99:242–247. - PubMed
    1. Koh Wui-Jin, Greer BE, Abu-Rustum NR, Apte SM. NCCN Clinical PracticeGuidelines in Oncology: Cervical cancer, V.1.2016. 2016 USA: National Comprehensive Cancer Network: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#cervical.