Analysis of Lymph Node Metastasis and Risk Factors in 975 Patients with FIGO 2009 Stage IA-IIA Cervical Cancer.

ABSTRACT

OBJECTIVES: The objective of this study was to summarize the rate of lymph node metastasis (LNM) of patients with stage IA-IIA cervical cancer and further analyze its distribution characteristics and related risk factors. DESIGN: This study is a retrospective analysis of clinical data about cervical cancer. PARTICIPANTS: According to the International Federation of Gynecology and Obstetrics (FIGO) 2009 staging standard, 975 patients with stage IA-IIA cervical cancer treated in our hospital from January 2010 to December 2018. SETTING: This is a single-center study. METHODS: The incidence and distribution of LNM were analyzed, and the influencing factors of cervical cancer LNM were analyzed using univariate and multivariate logistic regression. RESULTS: In this study, the LNM rate was 14.8% (144/975), and a total of 20,288 lymph nodes were removed, among which 359 lymph nodes had metastasis. According to the number and frequency of metastatic lymph nodes in different regions, the metastatic rate was the highest in the external iliac regions. Univariate analysis showed that more than three pregnancies, tumor size >4 cm, gross type, FIGO stage, pathological type, positive lymphovascular space invasion (LVSI), deep cervical stromal invasion (outer half invasion), parametrial involvement, and uterine corpus invasion (UCI) were correlated with LNM (p < 0.05). Multivariate analysis showed that tumor lesion of >4 cm (odds ratio (OR) = 2.253, 95% confidence interval (CI) 1.486-3.416, p < 0.001), positive LVSI (OR = 5.353, 95% CI 3.303-8.676, p < 0.001), deep cervical stromal invasion (OR = 3.461, 95% CI 2.106-5.688, p < 0.001), and deep UCI (myometrial invasion ≥50%) (OR = 3.529, 95% CI 1.321-9.427, p = 0.012) were independent risk factors for LNM. LIMITATIONS: Retrospective nature of the study and limitation to a single-center study are the limitations of the study. CONCLUSIONS: Patients with cervical cancer are more likely to have LNM with a tumor size of >4 cm, positive LVSI, deep cervical stromal invasion, or deep UCI. When these risk factors are present, the presence of LNM is possible, and attention should be paid. This study provides a certain reference value for predicting LNM risk for patients with early cervical cancer and for the stratified management of early cervical cancer treatment.