Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy

• Published in: Cancer 1999-04, Vol.85 (7), p.1547-1554
• Main Authors: Sakuragi, Noriaki, Satoh, Chikara, Takeda, Naoki, Hareyama, Hitoshi, Takeda, Mahito, Yamamoto, Ritsu, Fujimoto, Toshio, Oikawa, Mamoru, Fujino, Takafumi, Fujimoto, Seiichiro
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aorta; Biological and medical sciences; Carcinoma, Adenosquamous - pathology; Carcinoma, Squamous Cell - pathology; cervical carcinoma; Cervix; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Hysterectomy; Lymph Node Excision; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; lymph‐vascular space invasion; Medical sciences; Middle Aged; Neoplasm Staging; paraaortic lymph node metastasis; pelvic lymph node metastasis; Pelvis; Regression Analysis; Retroperitoneal Space; Risk Factors; sentinel lymph node; Tumors; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19990401)85:7<1547::AID-CNCR16>3.0.CO;2-2

BACKGROUND The incidence and distribution pattern of retroperitoneal lymph node metastasis in patients with cervical carcinoma should be investigated based on data from systematic pelvic lymph node (PLN) and paraaortic lymph node (PAN) dissection, so that a basis can be established for determining the site of selective lymph node dissection or sampling. METHODS A total of 208 patients with Stages IB, IIA, and IIB cervical carcinoma who underwent radical hysterectomy and systematic pelvic and PAN dissection were investigated for lymph node metastasis and histopathologic risk factors for lymph node metastasis. RESULTS Fifty‐three patients (25.5%) had lymph node metastasis. The obturator lymph nodes were most frequently involved, with a rate of 18.8% (39/208). Forty‐nine of 53 node‐positive patients had lymph node metastasis in the obturator, internal iliac, or common iliac lymph nodes. Of 26 solitary lymph node metastases confined to one node group, 18 were in the obturator, 3 in the internal iliac, 3 in the parametrial, and 2 in the common iliac lymph nodes. A multiple logistic regression analysis revealed that deep cervical stromal invasion and lymph‐vascular space invasion were related to PLN metastasis. It was also shown that metastasis to bilateral PLNs (excluding the common iliac lymph nodes) as well as metastasis to the common iliac lymph nodes were significantly related to PAN metastasis. CONCLUSIONS The results of this study suggest that the obturator lymph nodes can be sentinel lymph nodes of cervical carcinoma. PAN metastasis appears to occur secondarily to wide‐spread PLN metastasis. These results provide a basis for determining the site of selective lymph node dissection and for estimating the existence of PAN metastasis from the pattern of metastasis in PLN in patients with cervical carcinoma. Cancer 1999;85:1547–54. © 1999 American Cancer Society. Based on the results of systematic pelvic and paraaortic lymph node dissection in radical hysterectomy for 208 patients with cervical carcinoma, the obturator lymph nodes may be regarded as sentinel lymph nodes of cervical carcinoma, and paraaortic lymph node metastasis appears to be secondary to widespread pelvic lymph node metastasis. The existence of paraaortic lymph node metastasis may be estimated from the pattern of metastasis in pelvic lymph nodes in patients with cervical carcinoma.