scholarly journals Topographic distribution of lymph node metastasis in patients with stage IB1 cervical cancer: an analysis of 8314 lymph nodes

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jing Cai ◽  
Xiaoqi He ◽  
Hongbo Wang ◽  
Weihong Dong ◽  
Yuan Zhang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Pelvic Lymphadenectomy ◽  
Individual Treatment ◽  
Nodal Metastases ◽  
Tumor Spread ◽  
Node Metastasis ◽  
Parametrial Invasion

Abstract Background Systematic pelvic lymphadenectomy or whole pelvic irradiation is recommended for the patients with stage IB1 cervical cancer. However, the precise pattern of lymphatic tumor spread in cervical cancer is unknown. In the present study we evaluated the distribution of nodal metastases in stage IB1 cervical cancer to explore the possibilities for tailoring cancer treatment. Methods A total of 289 patients with cervical cancer of stage IB1, according to FIGO 2009, were retrospectively analyzed. All patients underwent laparoscopic radical hysterectomy (Querleu and Morrow type C2) and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy (level 2 or level 3 according to Querleu and Morrow) from October 2014 to December 2017. Lymph nodes removed from 7 well-defined anatomical locations as well as other tissues were examined histopathologically, and typed, graded, and staged according to the WHO/IARC classification. Results Totally 8314 lymph nodes were analyzed with the average number of 31.88 ± 10.34 (Mean ± SD) lymph nodes per patient. Nodal metastases were present in 44 patients (15.22%). The incidence of lymphatic spread to different anatomic sites ranged from 0% (presacral) to 30.92% (obturator nodes). Tumor size above 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion were shown to be significantly correlated with the higher risk of lymphatic metastasis, while obesity (BMI ≥ 25) was independently negatively associated with lymphatic metastases. Conclusions The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. Individual treatment could be considered for the selected low-risk patients who have smaller tumors and obesity and lack of the parametrial invasion or LVSI.

Identification of risk factors associated with pelvic lymph node metastasis in patients with stage IB1 cervical cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18005-e18005
Author(s):  
Ping Jiang ◽  
Jing Cai ◽  
Xiaoqi He ◽  
Hongbo Wang ◽  
Weihong Dong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Tumor Size ◽  
Node Metastasis ◽  
Parametrial Invasion ◽  
Pelvic Lymph Node Metastasis ◽  
Internal Iliac

e18005 Background: Evaluation the distribution of nodal metastases in the stage IB1 cervical cancer and the risk factors associated with pelvic lymph node metastasis (LNM) at each anatomic location. Methods: 728 patients with stage IB1 cervical cancer who underwent radical hysterectomies and systemic pelvic lymphadenectomies from January 2008 to December 2017 were retrospectively studied. All removed pelvic lymph nodes were pathologically examined, and the risk factors for LNM at the obturator, internal iliac, external iliac, and common iliac regions were evaluated by univariate and multivariate logistic regression analyses. Results: 20,134 lymph nodes were analysed with the average number of 27.80 (± SD 9.43) lymph nodes per patient. Nodal metastases were present in 266 (14.6%) patients. The obturator was the most common site for nodal metastasis (42.5%) followed by the internal iliac nodes (20.3%) and the external iliac nodes (19.9%), while the common iliac (9.8%) and parametrial (7.5%) nodes were the least likely to be involved. Tumor size more than 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion correlated independently significantly with the higher risk of the lymphatic metastasis. Obesity (BMI≥25) was independently significantly negatively correlated with the risk of lymphatic metastases. All the positive common iliac nodes were found in patients with tumors greater than 2 cm. The multivariate analysis showed that tumor size greater than 3 cm was associated with a 16.6-fold increase in the risk for common iliac LNM. Interestingly, tumor size was not an independent risk factor for pelvic LNM in the lower regions, i.e., the obturator, internal iliac and external iliac areas, where LVSI was the most significant predictor for LNM. In addition, parametrial invasion was related to external and internal iliac LNM; deep stromal invasion and age less than 50 years were associated with obturator LNM. Conclusions: The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. The data offer the opportunity for tailored individual treatment in selected patients with small tumors and obesity.

Can Pelvic Lymphadenectomy be Omitted in Stage IA2 to IIB Uterine Cervical Cancer?

2014 ◽  
Vol 24 (6) ◽  
pp. 1072-1076 ◽  
Author(s):  
Shinichi Togami ◽  
Masaki Kamio ◽  
Shintaro Yanazume ◽  
Mitsuhiro Yoshinaga ◽  
Tsutomu Douchi
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Uterine Cervical Cancer ◽  
Pelvic Lymphadenectomy ◽  
Pelvic Lymph Node ◽  
Node Metastasis ◽  
Parametrial Invasion ◽  
Pelvic Lymph Node Metastasis

ObjectivesThe aims of this study were to predict pelvic lymph node metastasis in uterine cervical cancer before surgery and to evaluate the potential efficacy of omitting pelvic lymphadenectomy.Materials and MethodsA total of 163 patients with invasive uterine cervical cancer in FIGO stage IA2 to IIB, all of whom underwent primary radical hysterectomy with pelvic lymphadenectomy, participated in this study.ResultsThe incidences of pelvic lymph node metastasis in stage IA2, stage IB1, stage IB2, stage IIA, and stage IIB cervical cancer were 0% (0/12), 17% (13/76), 22% (6/27), 33% (8/24), and 63% (15/24), respectively. A significant difference was observed in overall survival with nodal metastasis status (P< 0.0001). Univariate analysis revealed that parametrial invasion (P< 0.0001), tumor markers (P= 0.0006), tumor size greater than 2 cm (P< 0.0001), tumor size less than 3 cm (P= 0.0009), and tumor size greater than 4 cm (P= 0.0024) were correlated with pelvic lymph node metastasis. However, multivariate analysis revealed that parametrial invasion (P= 0.01; odds ratio, 3.37; 95% confidence interval, 1.31–9.0) and tumor size greater than 2 cm (P= 0.005; odds ratio, 4.93; 95% confidence interval, 1.54–22.01) were independently associated with nodal metastasis.ConclusionsPelvic lymphadenectomy may be avoided in patients with negative parametrial invasion and a tumor size less than 2 cm, thereby minimizing postoperative complications.

scholarly journals Pelvic Lymphadenectomy in the Treatment of Invasive Bladder Cancer: Literature Review

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Ehab A. Elzayat ◽  
Ali A. Al-Zahrani
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Lymphovascular Invasion ◽  
Tumor Burden ◽  
Pelvic Lymphadenectomy ◽  
Invasive Bladder Cancer ◽  
Node Density ◽  
Node Metastasis

The standard surgical treatment of invasive bladder cancer is the radical cystectomy and pelvic lymph node dissection (PLND). Up to one-third of patients with invasive bladder cancer have lymph node metastasis. Thus, PLND has important therapeutic and prognostic benefits. The number of lymph nodes that should be removed and the extent of the PLND are still a controversial issue. Recently, the trend of PLND increased toward more extended PLND. Several prognostic factors related to PLND were reported in the literature. In this paper, we will discuss the different PLND templates, number of lymph nodes that should be resected, lymph node density, lymphovascular invasion, tumor burden, extracapsular extension, and the aggregate lymph node metastasis diameter.

How should we stage and tailor treatment strategy in locally advanced cervical cancer? Imaging versus para-aortic surgical staging

2020 ◽  
Vol 30 (9) ◽  
pp. 1434-1443
Author(s):  
Alejandra Martinez ◽  
Martina Aida Angeles ◽  
Denis Querleu ◽  
Gwenael Ferron ◽  
Christophe Pomel
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Surgical Staging ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Node Metastasis ◽  
Pet Ct

Para-aortic lymph node status at initial assessment is the most important prognostic factor and a key point for the therapeutic strategy in patients with locally advanced cervical cancer. Undiagnosed lymph node metastasis is a major clinical problem as the finding of positive para-aortic lymph nodes leads to treatment modification, with a possible impact on disease free survival. When aortic lymph node disease is discovered, radiotherapy is extended to the para-aortic area, and other treatment modalities may be considered. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is the most accurate imaging examination to assess para-aortic extension in patients with locally advanced cervical cancer. The gold standard to identify para-aortic extension remains histologic evaluation of the lymph nodes. Indeed, PET/CT fails to detect approximately 10–15% of patients with negative PET/CT aortic nodes who have lymph node metastasis on pathologic staging. Patients with positive pelvic lymph nodes have para-aortic extension in 25–30% of cases, and surgical staging will lead to treatment modification and probably to improved para-aortic and distant control. Surgical staging also avoids unnecessary toxicity associated with extended field radiation in approximately 75% of patients with pelvic lymph node metastasis. The best modality to identify para-aortic extension is histological evaluation of the lymph nodes, but the survival benefit of surgical staging remains controversial. On the other hand, current studies include a majority of patients without pelvic lymph node spread, who are likely to be those who will benefit the least from surgical staging.

Comparison of Survival Outcomes with or Without Para-aortic Lymphadenectomy in Surgical Patients with Stage IB1-IIA2 Cervical Cancer in China from 2004-2016

2021 ◽  
Author(s):  
Chunlin Chen ◽  
Hui Duan ◽  
Wenling Zhang ◽  
Hongwei Zhao ◽  
Li Wang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Pelvic Lymphadenectomy ◽  
Pelvic Lymph Node ◽  
Surgical Patients ◽  
Survival Outcomes ◽  
Node Metastasis ◽  
Pelvic Lymph Node Metastasis ◽  
Aortic Lymph Node

Abstract Background: Current opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer.Methods: We retrospectively compared the survival outcomes of 8802 cervical cancer patients with stage IB1-IIA2 (FIGO 2009) from 37 hospitals in mainland China, who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n=8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n=357).Results: Among the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastasis, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph node metastasized, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity. Conclusion: Para-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.

Incidence of Lymph Node Metastases in Women With Low-Risk Early Cervical Cancer (<2 cm) Without Lymph-Vascular Invasion

2018 ◽  
Vol 28 (4) ◽  
pp. 788-793 ◽  
Author(s):  
Lucas Minig ◽  
Anna Fagotti ◽  
Giovanni Scambia ◽  
Gloria Salvo ◽  
María Guadalupe Patrono ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Lymph Node Involvement ◽  
Pelvic Lymphadenectomy ◽  
Low Risk ◽  
Node Metastasis ◽  
Vascular Space ◽  
Vascular Space Invasion

ObjectiveTo determine the incidence of lymph node metastasis in women with low-risk cervical cancer stage IA2 or IB1 (<2 cm) without lymph-vascular space invasion.MethodsA multicenter retrospective study was performed in patients who underwent radical or simple hysterectomy, conization, or trachelectomy plus pelvic lymphadenectomy for cervical cancer between January 2000 and June 2016.ResultsA total of 271 patients were included in the study. Median age and body mass index were 46 years (range, 23–77 years) and 24 kg/m2 (range, 18–48 kg/m2), respectively. Twenty-two patients had stage IA2 (8.1%), and 249 (91.9%) had stage IB1. The median tumor size was 14 mm (range, 5–20 mm). Tumor grades were 1 (n = 63 [23.2%]), 2 (n = 120 [44.3%]), 3 (n = 63 [23.2%]), and unknown (25 [9.2%]). Median depth stromal invasion was 6 mm (range, 3–20 mm). Histologic subtypes included squamous (n = 171 [63.1%]), adenocarcinoma (n = 92 [33.9%]), and adenosquamous (n = 8 [3.0%]). Overall incidence of lymph node metastasis was 2.9% (n = 8). The incidence of lymph node involvement in G1, G2, and G3 was 0% (0/63), 5% (6/120), and 3.1% (2/63), respectively. No patient with stage IA2 (regardless of grade or histology) or G1 cervical cancer less than 2 cm (stage IB1) had lymph node metastasis.ConclusionsPatients with stage IA2 or IB1 (G1) with tumor size of less than 2 cm and no lymph-vascular space invasion may not need lymph node evaluation. On the other hand, 95% and 98% of patients with grade 2 or 3 tumors, respectively, could potentially undergo an unnecessary lymphadenectomy. Further studies with bigger sample size are required to confirm these results.

scholarly journals The Proportion of Lymph Node Metastasis in Patients with Stage IIA1 and IIA2 Cervical Cancer who were Treated for Radical Hysterectomy and Pelvic Lymphadenectomy

2019 ◽  
pp. 65
Author(s):  
Andrijono Andrijono ◽  
Wahyu Ginealdy
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Radical Hysterectomy ◽  
Cross Sectional Study ◽  
Pelvic Lymphadenectomy ◽  
Cervical Cancer Patient ◽  
Cancer Stage ◽  
Cross Sectional ◽  
Node Metastasis

Objective: This study was designed to determine a difference in prognosis of stage IIA1 cervical cancer compared to stage IIA2 based on the incidence of metastasis to pelvic lymph nodes by radical hysterectomy. Methods:A cross sectional study was conducted among 108 stage II cervical cancer patient post radical hysterectomy in obstetric gynecologic department of Dr. CiptoMangunkusumo hospital since 2006-2016. Results: From 108 patients with cervical cancer stage IIA, 80 (74%) patients are stage IIA1 and the remaining the remaining 28 (26%) patients are stage IIA2. The average age of patients at stage IIA2 (47.79 years) younger than IIA1 (55.85 years) and also patient at stage IIA1 having a higher parity number which is 4 compare to stage IIA2 with the number of parity 2. The Involvement of lymph node metastasis in patients with stage IIA1 and IIA2 cervical cancer were 51 (63.75%) and 16 (57.14%) respectively. Conclusion: Metastatic factor to lymphnode in both stage have the same result. There was no difference in the proportion of lymph node metastasis occurring in both stage IIA cervical cancer stage which was corrected with radical hysterectomy and pelvic lymphadenectomy with p = 0,535. Changing staging does not seem to improve the prognosis. Keywords: cervical cancer, stage IIA, lymphnode metastatic   Tujuan:Membuktikan adanya perbedaan prognosis kanker servik stadium IIa1 dibanding stadium IIa2 berdasarkan kejadian metastasis ke kelenjar getah bening pelvik yang dilakukan histerektomi radikal. Metode: Dengan menggunakan metode potong lintang dilakukan pengambilan data  108 sampel pasien kanker serviks stadium IIA yang dilakukanpembedahanhisterektomiradikal di Departemen OnkologiGinekologi RSUP. Dr. Cipto Mangunkusumo Jakarta sejak tahun 2006 hingga tahun 2016. Hasil: Pasien kanker serviks stadium IIA1 sebanyak 80 (74%) pasien dan stadium IIA2 sebanyak 28 (26 %) pasien. Pada stadium IIA2 (47.79 tahun) didapatkan rata ratausiapasienlebihmudadibandingkan IIA1 (55.85 tahun). Pada stadium IIA1 jugadidapatkanjumlahparitas yang lebihtinggiyaitu 4 sedangkanpada stadium IIA2 denganjumlahparitas 2. Keterlibatan metastasis kelenjar getah bening pada pasien kanker serviks stadium IIA1 dan IIA2 berjumlah 51 (63.75%) dan 16 (57.14%) secara berurutan. Tidak terdapat perbedaan proporsi kejadian metastasis kelenjar getah bening pada kedua kelompok stadium kanker serviks pada stadium IIA dengan nilai p = 0,535. Kesimpulan: Faktor metastasis kelenjar getah bening pada kedua stadium memiliki hasil yang serupa.Tidak terdapat perbedaan proporsi kejadian metastasis kelenjar getah bening pada kedua kelompok stadium kanker serviks stadium IIA1 dan IIA2 yang ditatalaksna dengan histerektomi radikal dan limfadenektomi pelvis. Perubahan penetapan stadium sepertinya tidak memperbaiki prognosis. Kata kunci : Kanker serviks, stage IIA, kelenjar getah bening, faktor prognostik

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