Zhao Jing, Cai Jing, Wang Hongbo, Dong Weihong, Zhang Yuan, Wang Shaohai, He Xiaoqi, Sun Si, Huang Yuhui, Huang Bangxing, Willborn Kay C, Jiang Ping, Wang Zehua
Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
J Cancer. 2021 Mar 5;12(9):2624-2632. doi: 10.7150/jca.53215. eCollection 2021.
We aimed to identify the risk factors associated with pelvic lymph node metastasis (LNM) at each anatomic location in patients with stage IB1 cervical cancer. A primary cohort of 728 patients with stage IB1 cervical cancer who underwent radical hysterectomy and systematic pelvic lymphadenectomy were retrospectively studied. All removed pelvic nodes (=20,134) were pathologically examined. The risk factors for LNM in different anatomic regions (obturator, internal iliac, external iliac, and common iliac) were evaluated by multivariate logistic regression analyses. Nomograms were generated from the primary cohort and validated in another external cohort =242). The performance of the nomogram was assessed by its calibration and discrimination. Overall survival and progression-free survival in patients with different LNM patterns were compared. : LNM was found in 266 (1.3%) removed nodes and 106 (14.6%) patients. The incidences of LNM at the obturator, internal iliac, external iliac, common iliac, and parametrial regions were 8.5%, 5.4%, 4.7%, 1.9% and 1.8%, respectively. Among others, tumour size and lymph-vascular space invasion (LVSI), which are preoperatively assessable, were identified as independent risk factors of LNM in the common iliac region and the lower pelvis, respectively, and age was an additional independent risk factor of obturator LNM. The negative predictive values of tumour size <2 cm for common iliac LNM and negative LVSI combined with older age (> 50 years) for obturator LNM were 100% and 98.7%, respectively. A nomogram of these two factors showed good calibration and discrimination (concordance index, 0.761 in the primary cohort and 0.830 in validation cohort). The patients with common iliac LNM had poorer survival than those with LNM confined to the lower pelvis, while the differences in survival between patients with LNM confined to one node, one region or single side and those with more widely spreading LNM were not statistically significant. Tumour size, LVSI and age are region-specific risk factors for pelvic LNM in IB1 cervical cancer, which could be used to allocate the appropriate extent of pelvic lymphadenectomy.
我们旨在确定IB1期宫颈癌患者盆腔各解剖部位发生盆腔淋巴结转移（LNM）的相关危险因素。对728例行根治性子宫切除术和系统性盆腔淋巴结清扫术的IB1期宫颈癌患者的原始队列进行了回顾性研究。对所有切除的盆腔淋巴结（共20134个）进行了病理检查。通过多因素逻辑回归分析评估不同解剖区域（闭孔、髂内、髂外和髂总）LNM的危险因素。根据原始队列生成列线图，并在另一个外部队列（n = 242）中进行验证。通过校准和鉴别评估列线图的性能。比较了不同LNM模式患者的总生存期和无进展生存期。结果显示：在切除的淋巴结中有266个（1.3%）发现LNM，106例（14.6%）患者发生LNM。闭孔、髂内、髂外、髂总和宫旁区域LNM的发生率分别为8.5%、5.4%、4.7%、1.9%和1.8%。其中，术前可评估的肿瘤大小和淋巴血管间隙浸润（LVSI）分别被确定为髂总区域和骨盆下部LNM的独立危险因素，年龄是闭孔LNM的另一个独立危险因素。肿瘤大小<2 cm对髂总LNM的阴性预测值以及LVSI阴性联合年龄较大（>50岁）对闭孔LNM的阴性预测值分别为100%和98.7%。这两个因素的列线图显示出良好的校准和鉴别能力（一致性指数，原始队列中为0.761，验证队列中为0.830）。髂总LNM患者的生存期比LNM局限于骨盆下部的患者差，而LNM局限于一个淋巴结、一个区域或单侧的患者与LNM广泛扩散的患者之间的生存差异无统计学意义。肿瘤大小、LVSI和年龄是IB1期宫颈癌盆腔LNM的区域特异性危险因素，可用于确定盆腔淋巴结清扫术的合适范围。
