Influencing Factors Of Lymph Node Metastasis In The Conization Specimens Of Early-stage Cervical Cancer

Objective:Lymph node metastasis(LNM)is considered to be one of the three high risk factors affecting the prognosis of patients with cervical cancer.At present,the study on the influencing factors of cervical cancer lymph node metastasis is mainly based on the study of pathological factors of specimens after radical hysterectomy(RH).However,there are few literatures about whether the lymph node status can be evaluated before radical hysterectomy.The aim of this study was to study the influencing factors of lymph node metastasis in conical specimens before radical hysterectomy in patients with early cervical cancer.Methods:133 Patients with cervical cancer diagnosed from January 2012 to May2020 were collected.These patients were diagnosed as cervical cancer by FIGO stage IA2～IB1 and underwent radical hysterectomy+pelvic lymphadenectomy after cervical conization in Dalian Obstetrics and Gynecology Hospital Affiliated to Dalian Medical University(our hospital).All the patients in the study were operated by senior gynecologic oncologists in our hospital,and the pathological sections were re-read by gynecological tumor pathologists in the pathology department of our hospital.The content of re-reading mainly includes whether there is lymphatic vascular space infiltration,marginal stateand cervical interstitial infiltration depth,etc.All patients were re-staged according to the FIGO(2018).The clinical data of the patients were collected,including operative age,BMI,pathological type,FIGO stage,histopathological grade,tumor diameter,depth of cervical interstitial infiltration,tumor growth pattern,cutting edge status,lymphatic vascular space infiltration,conization mode,abdominal route of radical hysterectomy,serum squamous cell carcinoma antigen(SCC-Ag)and platelet count,to analyze the relationship between clinicopathological factors and lymph node metastasis of early cervical cancer.The data were analyzed by SPSS 25.0 statistical software.The t-test of two independent samples and chi-square test(X~2)or Fisher exact probability method were used for univariate analysis.Multivariate analysis was used to identify the independent risk factors of lymph node metastasis by binary Logistic regression analysis.The difference of definition was statistically significant(P<0.05).Results:133 patients who met the inclusion criteria,aged from 27 to 70 years old.There were 18 patients with positive lymph node metastasis(13.53%)and 115 patients with negative lymph node metastasis(86.47%).Univariate analysis showed that lymph node metastasis was not related to operative age,BMI,pathological type,histopathological grade,tumor growth pattern,cutting edge state,conical resection mode,abdominal route of radical hysterectomy,serum squamous cell carcinoma antigen and platelet count.It was related to FIGO stage,tumor diameter,depth of cervical interstitial infiltration and lymphatic vascular space infiltration(all P<005).Multivariate analysis showed that positive lymphatic vascular space infiltration(OR=0.145,95%CI:0.037～0.575,P=0.006)and tumor diameter≥1cm(OR=0.245,95%CI:0.074～0.809,P=0.021)were independent risk factors for lymph node metastasis.Conclusions:Lymph node metastasis of early cervical cancer is related to late FIGO stage,tumor diameter≥1cm,cervical interstitial invasion≥5mm and lymphatic vascular space infiltration.Lymphatic vascular space infiltration and tumor diameter can be used as independent predictors of lymph node metastasis.