Risk Factors of Pelvic Lymph Node Metastasis and Recurrence in Patients with Early Cervical Cancer

Background: Pelvic lymph node metastasis (PLNM) is one of the critical factors affecting the postoperative prognosis of patients with cervical cancer. Preoperative identification of risk factors for PLNM can optimize preoperative treatment plans and prognostic assessments.The purpose of this study was to investigate the risk factors for PLNM and its recurrence in patients undergoing radical hysterectomy for cervical cancer.Methods: Medical records of 245 patients who underwent radical hysterectomy and bilateral pelvic lymphadenectomy as primary treatment for the International Federation of Gynaecology and Obstetrics (FIGO,2009) stage IA-IIA cervical cancer between January 2010 and December 2015 were reviewed. Clinicopathological risk factors were retrospectively analyzed. All patients were followed up for 5–10 years. Multivariate analysis was performed using a logistic regression model for the analysis of risk factors for PLNM.Results: Preoperative hemoglobin level, FIGO stage, LVSI, parametrial infiltration, and tumor diameter differed significantly between the two groups (P<0.05).Multivariate analysis revealed preoperative hemoglobin <110 g/L, FIGO stage II, LVSI, parametrial infiltration, and tumor diameter ≥4 cm as significant risk factors for PLNM and recurrence of cervical cancer after surgery (P<0.05). PLNM was identified as the independent risk factor for recurrence in patients with cervical cancer after surgery (P<0.05).Conclusions: Patients with PLNM have a high recurrence rate, and postoperative follow-up should be closely followed to ensure timely detection of recurrence and treatment. For patients at high risk of PLNM, intraoperative careful and comprehensive pelvic lymph node resection should be performed to avoid missing metastatic lymph nodes and affecting the prognosis. Given the many complications of pelvic lymph node dissection for the low-risk population, further research is needed to determine whether pelvic lymphadenectomy should be attempted only in high-risk individuals.

Comparison of survival outcomes with or without Para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer in China from 2004 to 2016

Background Current opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer. Methods We retrospectively compared the survival outcomes of 8802 stage IB1-IIA2 cervical cancer patients (FIGO 2009) who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n = 8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n = 357) from 37 hospitals in mainland China. Results Among the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastases, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph nodes had metastases, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity. Conclusion Para-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.

Risk Factors for Pelvic Lymph Node Metastasis and Recurrence in Patients Undergoing Radical Hysterectomy for Cervical Cancer

Background: Radical hysterectomy and bilateral pelvic lymphadenectomy are standard treatments for early-stage cervical cancer. Pelvic lymph node metastasis (PLNM) is one of the critical factors affecting the postoperative prognosis of patients. Therefore, the identification of preoperative risk factors for PLNM will minimize its occurrence and improve prognosis. The purpose of this study was to investigate the risk factors for PLNM and its recurrence in patients undergoing radical hysterectomy for cervical cancer.Methods: Medical records of 245 patients who underwent radical hysterectomy and bilateral pelvic lymphadenectomy as primary treatment for the International Federation of Gynaecology and Obstetrics (FIGO) stage IA-IIA cervical cancer between January 2010 and December 2015 at our hospital were reviewed. Age, FIGO stage, preoperative hemoglobin level, depth of stromal invasion, lymphovascular space invasion (LVSI), human papillomavirus(HPV) infection, parametrial infiltration, tumor diameter, number of lymphadenectomies, and pathological type were retrospectively analyzed. All patients were followed up for 5–10 years.Results: Among the 245 patients, 185 (75.51%) had no PLNM, whereas 60 (24.49%) had PLNM. Preoperative hemoglobin level, FIGO stage, LVSI, parametrial infiltration, and tumor diameter differed significantly between the two groups (P<0.05). Multivariate analysis revealed preoperative hemoglobin <110 g/L, FIGO stage II, LVSI, parametrial infiltration, and tumor diameter ≥4 cm as significant risk factors for PLNM and recurrence of cervical cancer after surgery (P<0.05). PLNM was identified as the independent risk factor for recurrence in patients with cervical cancer after surgery (P<0.05).Conclusions: PLNM is an important prognostic indicator for the clinical treatment of cervical cancer. Patients at a high risk of recurrence, especially PLNM patients, should be followed up closely after surgery to ensure the timely detection of recurrence and treatment.

Comparison of Survival Outcomes with or Without Para-aortic Lymphadenectomy in Surgical Patients with Stage IB1-IIA2 Cervical Cancer in China from 2004-2016

Background: Current opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer.Methods: We retrospectively compared the survival outcomes of 8802 cervical cancer patients with stage IB1-IIA2 (FIGO 2009) from 37 hospitals in mainland China, who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n=8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n=357).Results: Among the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastasis, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph node metastasized, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity. Conclusion: Para-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.

Effect of Nano-Tracer on Identification of Sentinel Lymph Nodes in Pelvic Cavity and Postoperative Complications in Patients with Cervical Cancer

Cervical cancer is the most common malignant tumor of the female reproductive system. Its incidence rate ranks first among female malignant tumors in China and has been increasing in recent years. However, pelvic lymph node metastasis is an important factor affecting the prognosis of cervical cancer, because pelvic lymph node metastasis determines the scope of surgery, it is also an important basis for postoperative adjuvant treatment. Therefore, an accurate and effective method is needed to detect the presence of lymphatic metastases in time to guide the need for systematic pelvic lymph node dissection. This article explores the clinical application of nano-tracer in the surgical treatment of cervical cancer patients and the impact of postoperative complications on patients with pelvic sentinel lymph nodes. The results show that the success rate of sentinel lymph node tracing in cervical cancer surgery is high, and it is a safe and efficient lymph tracer, which can provide an effective way to study cervical micro metastasis and lymphatic chemotherapy.