Lymph nodes metastasis in cervical cancer: Incidences, risk factors, consequences and imaging evaluations

The aim of this study was to determine the incidence, risk factors, consequences and accuracy of imaging evaluation of lymph node (LN) metastasis in a cohort of 406 patients treated with radical hysterectomy (RH), lymphadenectomy of pelvic LN (PLN) and para-aortic LN (PALN), which was performed primarily by one physician.

From February 2001 to November 2015, patients with cervical cancer of FIGO stage IB were included, if they received RH of class III or type C performed by Dr. M. Wu in Peking Union Medical College Hospital. Follow-up ended in December 2016. Incidences and accuracy of imaging evaluation of LN metastasis were described, and predictive factors of LN metastasis and its impact on survival outcomes were determined in univariate and multivariate models.

Among 406 patients with clinical stage IB, 57 (14.0%) had lymphatic metastasis. In multivariate model, positive parametrium was independent factor for general LN metastasis (odds ratio [OR] 5.1; 95% confidence interval [95% CI], 2.1-12.1) and PLN metastasis (OR 5.3; 95% CI, 2.2-12.8). Positive PLN was independent factor for metastasis to common iliac LN and PALN. After adjusted with clinico pathologic factors, general and site-specific LN metastases were independent risk factors of progression-free survival and overall survival (all P values <0.05). Preoperative imaging evaluation had low sensitivity but high specificity for predicting LN metastasis. Various imaging methods had similar predictive accuracy.

Lymphatic metastasis was significantly related to the clinico pathologic characters and survival of cervical cancer. More sensitive preoperative evaluation is needed for predicting the LN metastasis.