Predictive Factors Of Pelvic Lymph Node Metastasis And The Significance Of The Number And The Status Of Lymph Nodes Removed In Stage IB1 Cervical Cancer

Objective:To identify the pathologic factors associated with pelvic lymph node metastasis of early cervical cancer;Effect of pelvic lymph node metastasis on the prognosis of early cervical cancer;The effect of different number of lymph node resected on the prognosis of patients with pelvic lymph node metastasis(PLNM group)and patients without pelvic lymph node metastasis(non-PLNM group);To explore the prediction model of pelvic lymph node metastasis in early stage cervical cancer.\Methods:A retrospective of clinicopathological data from 483 patients diagnosed with stage IB1(2009 International Federation of Gynecology and Obstetrics)cervical cancer was reviewed,who were treated by radical hysterectomy plus pelvic lymphadenectomy in Tian Jin Central Hospital of Gynecology Obstetrics from January 2013 to August 2018.Statistical data were analysed by SPSS 22.0.Different pathological factors between lymph node status were tested using the chi-square test and Fisher’s exact test.Multivariate analysis was performed using logistic regression analysis to identify independent pathological factors associated with LNM.Survival outcomes(RFS and OS)were compared between different lymph node status and different numbers of lymph node removed by the Kaplan Meier method and log-rank test.Results:1.The incidence of PLNM in our study was 13%.Univariate analysis showed that deep stromal invasion(DSI)、tumor size>2cm、 lymph vascular invasion(LVSI)、parametrial involvement(PI),growth pattern,degree of differentiation,higher numbers of pelvic lymph node removed were closely related to PLNM.The outcome of multivariate analysis was that LVSI(OR=5.242,95%CI:1.969-13.952,P=0.001)、PI(OR: 4.814,95%CI:1.651-14.032,P=0.004)、DSI(OR=4.628,95%CI: 2.342-9.144,P<0.0001)and tumor size>2cm(OR=2.937,95%CI:1.341-6.430,P=0.007)were independent pathological factors related with PLNM.2.With a median follow-up time was 34.4 months,The 5-year over-all survival of the patients with PLNM and the patients without PLNM were 74.6% and 96.4%,respectively.Also a significantly different result was found in the 5-year recurrence-free survival(73% with PLNM versus 96.2% without PLNM).3.Among patients with PLNM,the OS of patients with less than 23 nodes resected and patients with equal to or more than 23 nodes resected were 69.2% and 74%,respectively(P=0.889)and the RFS were 69.2% and 72%,respectively(P=0.878).Similarly,for patiens with non-PLNM,the OS of patients with less than 23 nodes resected and patients with equal or more than 23 nodes resected were 97.9% and 96.4%,respectively(P=0.293)and the RFS were 97.9% and 96%,respectively(P=0.255).Conclusion:1.The frequency of pelvic lymph node metastasis in the early cervical cancer was relatively low,especially with a tumor confined to the cervix.The independent pathological factors associated with PLNM in patients of stage IB1(2009)cervical cancer were LVSI、DSI 、PI and tumor size>2cm.2.PLNM was associated with significantly poor survival and with the increase of the number of metastatic lymph node,a worse prognosis could be seen.3.Although,the importance of lymphadenectomy was always emphasizing,it iseemed that there was no significantly different oncological outcomes between the number of removed nodes and OS or RFS.4.Nevertheless,we also found that almost 40% patients with tumor size >2cm and DSI had lymph node metastasis.And LVSI was identified more than 75% in that group.So,we sincerely suggest that it is better to receive concurrent radiochemotherapy rather than undergo radical hysterectomy plus lymphadenectomy for elderly patents who were diagnosed with a tumor more than 2cm and DSI.