Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy

Abstract

BACKGROUND The incidence and distribution pattern of retroperitoneal lymph node metastasis in patients with cervical carcinoma should be investigated based on data from systematic pelvic lymph node (PLN) and paraaortic lymph node (PAN) dissection, so that a basis can be established for determining the site of selective lymph node dissection or sampling. METHODS A total of 208 patients with Stages IB, IIA, and IIB cervical carcinoma who underwent radical hysterectomy and systematic pelvic and PAN dissection were investigated for lymph node metastasis and histopathologic risk factors for lymph node metastasis. RESULTS Fifty‐three patients (25.5%) had lymph node metastasis. The obturator lymph nodes were most frequently involved, with a rate of 18.8% (39/208). Forty‐nine of 53 node‐positive patients had lymph node metastasis in the obturator, internal iliac, or common iliac lymph nodes. Of 26 solitary lymph node metastases confined to one node group, 18 were in the obturator, 3 in the internal iliac, 3 in the parametrial, and 2 in the common iliac lymph nodes. A multiple logistic regression analysis revealed that deep cervical stromal invasion and lymph‐vascular space invasion were related to PLN metastasis. It was also shown that metastasis to bilateral PLNs (excluding the common iliac lymph nodes) as well as metastasis to the common iliac lymph nodes were significantly related to PAN metastasis. CONCLUSIONS The results of this study suggest that the obturator lymph nodes can be sentinel lymph nodes of cervical carcinoma. PAN metastasis appears to occur secondarily to wide‐spread PLN metastasis. These results provide a basis for determining the site of selective lymph node dissection and for estimating the existence of PAN metastasis from the pattern of metastasis in PLN in patients with cervical carcinoma. Cancer 1999;85:1547–54. © 1999 American Cancer Society.

Clinical significance of tumor volume and lymph node involvement assessed by MRI in stage IIB cervical cancer patients treated with concurrent chemoradiation therapy

“…Para-aortic metastases were found in 4.5 to 7.2% of patients in this stage. [16][17][18] Higher 5-year survival rates of ＞90% are reported among patients treated surgically with no evidence of LN metastasis, compared to patients with positive pelvic node (50 to 60%, 5-year survival) or para-aortic nodes (20 to 30%, 5-year survival). 19 Although it is accepted commonly that patients with para-aortic LN metastases have lower OS and higher recurrence, the incidence of pelvic or para-aortic LN involvement and 5-year survival rates were relatively higher than previous studies.…”

Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma

“…This rate was similar to the rate typically observed in patients with early cervical carcinoma. 4 Multilevel sectioning and IHC analysis revealed a relatively high rate of micrometastases in the pelvic lymph nodes (19% [5 of 26 patients]). This increased metastatic tumor detection rate is similar to what has been observed in patients with breast carcinoma.…”

“…Pelvic lymphadenectomy currently is the standard technique used to identify regional lymph node metastases in patients with cervical carcinoma. 4 This procedure is associated with significant intraoperative and postoperative morbidity, including motor and sensory nerve injury, lymphocysts, and leg lymphedema. It has been suggested that occult disease may be a predictive factor for the 15% of patients with lymph node-negative disease who experience recurrence.…”

Prognostic significance of positive lymph node number in early cervical cancer

“…The 5-year OS rates for patients with 0, 1, 2-3 and ≥4 positive nodes were 89, 81, 41 and 23%, respectively. Sakuragi et al (18) have reported the cumulative 5-year OS rates for patients with 1 and ≥2 positive nodes to be 84.9 and 26.5%, respectively, with no difference between cumulative OS rates of patients with 0 and those with 1 positive node.…”