Risk factors of pelvic lymph node metastasis in cervical adenocarcinoma following radical hysterectomy and pelvic lymphadenectomy.

BACKGROUND

Lymph node metastasis is the most important prognostic factor in cervical cancerpatients. However, most of the available knowledge about risk factors of pelvic nodal metastasis in cervical cancer has come from studies in which the majority of patients had the squamous cell carcinoma (SCC) subtype.

OBJECTIVE

To determine the risk factors of pelvic lymph node metastasis in early-stage cervical adenocarcinoma (AC) patients following radical hysterectomy and bilateral pelvic lymphadenectomy.

MATERIAL AND METHOD

Retrospective reviews were carried out of the medical charts and pathologic slides of 251 patients with cervical AC stage IB1-IIA who underwent radical hysterectomy and bilateral pelvic lymphadenectomy at Rajavithi Hospital from January 1, 2000 to December 31, 2011. The risk factors of pelvic lymph node metastasis were analyzed by multiple logistic regression.

RESULTS

Of the 251 patients, pelvic node metastasis in stage IB1-IIA cervical AC was detected in 29 patients (11.6%). Multivariable analysis revealed that clinical stage IB2-IIA (adjusted OR 3.4, 95%CI 1.2-9.7), tumor size more than 2 cm (adjusted OR 3.5, 95%CI 1.1-11.8), and positive lymphovascular invasion (LVSI) (adjusted OR 55.5, 95%CI 7.2-427.6) were significantly associated with pelvic nodal metastasis. Early-stage cervical AC patients with no risk factor, one risk factor other than LVSI, LVSI factor alone, two risk factors, and three risk factors were identified as having pelvic nodal metastasis in 0%, 2.3%, 9.1%, 29.1% and 58.8% of cases respectively.

CONCLUSION

Clinical stage IB2-IIA, tumor size of more than 2 cm, and positive LVSI were significant risk factors for pelvic nodal metastasis in early-stage cervical AC patients. Those with no risk factors were not found to have pelvic nodal metastasis and might be candidates for less radical surgery, whereas patients with the presence of LVSI and/or 2 other risk factors were found to be at high risk of pelvic node metastasis and might benefit from extensive lymphadenectomy and adjuvant therapy.