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J Gynecol Oncol. 2018 Jan;29(1):e11. doi: 10.3802/jgo.2018.29.e11.

Risk stratification models for para-aortic lymph node metastasis and recurrence in stage IB-IIB cervical cancer.

Author information

1
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA. koji.matsuo@med.usc.edu.
2
Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
3
Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan. muneaki.shimada.b7@tohoku.ac.jp.
4
Department of Gynecology, Tohoku University Hospital, Miyagi, Japan.
5
Department of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Hokkaido, Japan.
6
Department of Gynecologic Oncology, Shikoku Cancer Center, Matsuyama, Japan.
7
Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan.
8
Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan.
9
Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, Gifu, Japan.
10
Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan.
11
Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan.
#
Contributed equally

Abstract

OBJECTIVE:

To examine the surgical-pathological predictors of para-aortic lymph node (PAN) metastasis at radical hysterectomy, and for PAN recurrence among women who did not undergo PAN dissection at radical hysterectomy.

METHODS:

This is a retrospective analysis of a nation-wide cohort study of surgically-treated stage IB-IIB cervical cancer (n=5,620). Multivariate models were used to identify independent surgical-pathological predictors for PAN metastasis/recurrence.

RESULTS:

There were 120 (2.1%) cases of PAN metastasis at surgery with parametrial involvement (adjusted odds ratio [aOR]=1.65), deep stromal invasion (aOR=2.61), ovarian metastasis (aOR=3.10), and pelvic nodal metastasis (single-node aOR=5.39 and multiple-node aOR=33.5, respectively) being independent risk factors (all, p<0.05). Without any risk factors, the incidence of PAN metastasis was 0.9%, while women exhibiting certain risk factor patterns (>20% of the study population) had PAN metastasis incidences of ≥4%. Among 4,663 clinically PAN-negative cases at surgery, PAN recurrence was seen in 195 (4.2%) cases that was significantly higher than histologically PAN-negative cases (2.5%, p=0.046). In clinically PAN-negative cases, parametrial involvement (adjusted hazard ratio [aHR]=1.67), lympho-vascular space invasion (aHR=1.95), ovarian metastasis (aHR=2.60), and pelvic lymph node metastasis (single-node aHR=2.49 and multiple-node aHR=8.11, respectively) were independently associated with increased risk of PAN recurrence (all, p<0.05). Without any risk factors, 5-year PAN recurrence risk was 0.8%; however, women demonstrating certain risk factor patterns (>15% of the clinically PAN-negative population) had 5-year PAN recurrence risks being ≥8%.

CONCLUSION:

Surgical-pathological risk factors proposed in this study will be useful to identify women with increased risk of PAN metastasis/recurrence.

KEYWORDS:

Cervical Cancer; Early Stage; Metastasis; Para-aortic Lymph Node; Radical Hysterectomy; Recurrence

PMID:
29185269
PMCID:
PMC5709521
DOI:
10.3802/jgo.2018.29.e11
[Indexed for MEDLINE]
Free PMC Article

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