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Surgical‐pathologic risk factors of pelvic lymph node metastasis in stage Ib1‐IIb cervical cancer

Objective. To study the distribution characteristics and risk factors of cervical cancer lymph node metastasis (LNM). Design. Retrospective study. Setting. Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology and Affiliated Hospital to Zunyi Medical College. Population. 404 women diagnosed with cervical cancer FIGO stage Ib1‐IIa who underwent primary radical surgery and 104 women with Ib2‐IIb tumors treated with neoadjuvant chemotherapy (NACT) before surgery. Methods. Clinicopathological data were collected and analyzed. Main outcome measures. Incidence of infiltration, metastasis and pelvic LNM. Results. In women without NACT, the incidence of infiltration, metastasis and LNM was 7.2, 17.6 and 15.8%, respectively. Metastasis and LNM were significantly associated with advanced FIGO stage and poorer histological grade. The incidence of multiple metastatic lymph nodes (MLNs), bilateral LNM, skip LNM, LNM in primary group and LNM in secondary group was 6.2, 3.0, 6.2%, 11.4 and 4.5%, respectively. Of the 111 MLNs, 13 (11.7%) were common iliac lymph nodes. In the NACT group, infiltration, metastasis and LNM were observed in 10 (9.6%), 24 (23.1%) and 21 (20.1%) of 104 women, respectively. Metastasis and LNM were significantly correlated with moderate cell differentiation. Conclusion. High LNM risk is expected in tumors of IIa stage or higher and in moderately differentiated tumors. Skip metastasis and common iliac LNM are relatively common and therefore should not be neglected. Our results suggest that standardized and complete pelvic lymph node dissection under surgery is an important measure to ensure a therapeutic effect.