J Gynecol Oncol.
2018 Jan;29(1):e11. 10.3802/jgo.2018.29.e11.
Risk stratification models for para-aortic lymph node metastasis and recurrence in stage IB–IIB cervical cancer
- Affiliations
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- 1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA. koji.matsuo@med.usc.edu
- 2Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
- 3Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan. muneaki.shimada.b7@tohoku.ac.jp
- 4Department of Gynecology, Tohoku University Hospital, Miyagi, Japan.
- 5Department of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Hokkaido, Japan.
- 6Department of Gynecologic Oncology, Shikoku Cancer Center, Matsuyama, Japan.
- 7Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan.
- 8Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan.
- 9Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, Gifu, Japan.
- 10Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan.
- 11Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan.
- KMID: 2395238
- DOI: http://doi.org/10.3802/jgo.2018.29.e11
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.
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