Risk stratification models for para-aortic lymph node metastasis and recurrence in stage IB–IIB cervical cancer

Koji Matsuo, Muneaki Shimada, Tsuyoshi Saito, Kazuhiro Takehara, Hideki Tokunaga, Yoh Watanabe, Yukiharu Todo, Ken Ichirou Morishige, Mikio Mikami, Toru Sugiyama

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22 Citations (Scopus)

Abstract

Objective: To examine the surgical-pathological predictors of para-aortic lymph node (PAN) metastasis at radical hysterectomy, and for PAN recurrence among women who did not undergo PAN dissection at radical hysterectomy. Methods: This is a retrospective analysis of a nation-wide cohort study of surgically-treated stage IB–IIB cervical cancer (n=5,620). Multivariate models were used to identify independent surgical-pathological predictors for PAN metastasis/recurrence. Results: There were 120 (2.1%) cases of PAN metastasis at surgery with parametrial involvement (adjusted odds ratio [aOR]=1.65), deep stromal invasion (aOR=2.61), ovarian metastasis (aOR=3.10), and pelvic nodal metastasis (single-node aOR=5.39 and multiple-node aOR=33.5, respectively) being independent risk factors (all, p<0.05). Without any risk factors, the incidence of PAN metastasis was 0.9%, while women exhibiting certain risk factor patterns (>20% of the study population) had PAN metastasis incidences of ≥4%. Among 4,663 clinically PAN-negative cases at surgery, PAN recurrence was seen in 195 (4.2%) cases that was significantly higher than histologically PAN-negative cases (2.5%, p=0.046). In clinically PAN-negative cases, parametrial involvement (adjusted hazard ratio [aHR]=1.67), lympho-vascular space invasion (aHR=1.95), ovarian metastasis (aHR=2.60), and pelvic lymph node metastasis (single-node aHR=2.49 and multiple-node aHR=8.11, respectively) were independently associated with increased risk of PAN recurrence (all, p<0.05). Without any risk factors, 5-year PAN recurrence risk was 0.8%; however, women demonstrating certain risk factor patterns (>15% of the clinically PAN-negative population) had 5-year PAN recurrence risks being ≥8%. Conclusion: Surgical-pathological risk factors proposed in this study will be useful to identify women with increased risk of PAN metastasis/recurrence.

Original languageEnglish
Article numbere11
JournalJournal of gynecologic oncology
Volume29
Issue number1
DOIs
Publication statusPublished - 2018 Jan

Keywords

  • Cervical cancer
  • Early stage
  • Metastasis
  • Para-aortic lymph node
  • Radical hysterectomy
  • Recurrence

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

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