Do the pelvic lymph nodes predict the parametrial status in cervical cancer stages IB-IIA?

Abstract

The aim of this study was to determine whether the pelvic lymph nodes would predict the parametrial status in patients with cervical cancer stages IB1-IIA submitted to radical surgery and pelvic lymphadenectomy. To this end, we evaluated the relationship between positive and negative pelvic lymph nodes and their parametria. Our final purpose was to use this information to recommend the tailoring of the parametrial resection according to the status of pelvic lymph nodes to decrease the morbidity related with radical paratrectomy. From January 1996 to December 2001, 107 consecutive patients with cervical cancer stages IB1 and IIA were primarily treated by radical hysterectomy type III with systematic pelvic lymphadenectomy in a prospective study. Parametria were studied in two sections: the first included the tissue adjacent to the cervix, and the second the distal 2/3. Lymph nodes were routinary processed. Twenty-two patients (20.6%) had positive pelvic nodes and 16 patients (14.9%) had parametrial involvement, mostly by direct extension. Eight patients with positive pelvic nodes (36.4%) had parametrial involvement, whereas among 85 patients with negative pelvic nodes only eight patients (9.4%) had parametrial involvement (P < 0.001), most in internal parametria (62.5%). The sensitivity of pelvic lymph nodes for parametrial involvement was 50% and the positive predictive value was 36.4%, whereas the specificity was 84.6%; and the negative predictive value 90.6%. In the group of negative pelvic lymph nodes, only two patients (2.3%) had parametrial involvement beyond internal parametria. The univariated and multivariated analysis of prognostic factors was always significant but without a significant independent factor for positive parametria. Pelvic lymph nodes appear as good predictors of parametrial status, especially in node-negative patients, and could be used to decrease the paratrectomy in radical surgery.

Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer

“…Kodama et al, reported that pelvic lymph node status is the strongest independent predictor of parametrial involvement [14]. Similarly, Puente et al, suggested that pelvic lymph node status is a good predictor of parametrial involvement in node-negative patients in whom less radical surgery could be used [15]. In our study, we found that LVSI, deep cervical stromal invasion, lymph node metastasis, and tumor size are significant risk factors for parametrial involvement in patients with clinical early-stage cervical cancer.…”

Occult parametrial metastasis in operable cancer cervix: is a routine radical hysterectomy justified?

“…Out of the 62 patients who were operated, 28 patients received adjuvant RT, 23 for lymph nodal metastasis (LNM) [out of which 9 also had occult parametrial metastasis (OPM)] and 5 patients for presence of two or more intermediate risk factors (LVSI, PTD>2cm, DSI). 5,7,8 However, Benedetti-Panici et al in their study of patterns of parametrial involvement and LN metastasis found that lateral parametrium was the most common site of PM and that too by tumor embolization and hence OPM could occur independently and unpredictably in both lateral and medial parametrium. This led sceptics to believe that entire parametrium needs to be routinely removed irrespective of other factors though Puente et al has contradicted this finding in their study.…”

“…This led sceptics to believe that entire parametrium needs to be routinely removed irrespective of other factors though Puente et al has contradicted this finding in their study. 2,7 It has also been debated whether taking a chance with oncological safety is going to benefit the patient significantly? The entire purpose of limiting the radicality of parametrial resection is to avoid possible long-term complications (Fistulae, bladder dysfunction, anal dysfunction and sexual dysfunction) that occur due to visceral damage and injuries to autonomic nerves and the complications of fibrosis and endarteritis especially after adjuvant RT.…”

“…5,6 This was based on the premise that PM does not occur in the absence of certain high-risk factors (Tumor size, LVSI, Deep stromal invasion (DSI), PLM) and identification of a low risk subgroup of patients would enable a less radical procedure, even a simple hysterectomy to replace RH. 7,8 This would not only reduce the morbidity but also ensure wider availability of this less radical surgical option in resource starved environments with limited availability of expertise to perform a RH. However, sceptics oppose this concept based on the evidence from some studies that suggest that PM occurs in both medial and lateral parametrium independently and may not be predictable on the basis of risk factors.…”

Compromiso parametrial en pacientes con cáncer de Cérvix IB-1 tratadas con histerectomía radical en Perú

“…Se encontró que el estado ganglionar linfático pélvico es el predictor independiente más fuerte para presentar CP, conjuntamente con la profundidad de infiltración. Este factor ha sido previamente reportado como un predictor sólido de propagación parametrial (7,18,(21)(22)(23)(24)(25)(26)(27)(28) .…”