Predictive factors of para-aortic lymph nodes metastasis in cervical cancer patients: a retrospective analysis based on 723 para-aortic lymphadenectomy cases

// Xiaotian Han 1,2,* , Hao Wen 1,2,* , Xingzhu Ju 1,2 , Xiaojun Chen 1,2 , Guihao Ke 1,2 , Yuqi Zhou 1,2 , Jin Li 1,2 , Lingfang Xia 1,2 , Jia Tang 1,2 , Shanhui Liang 1,2 and Xiaohua Wu 1,2 1 Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, PR China 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China * These authors have contributed equally to this work Correspondence to: Xiaohua Wu, email: // Keywords : cervical cancer, para-aortic lymph node, pelvic lymph node, lymphadenectomy, SCCA Received : October 07, 2016 Accepted : February 21, 2017 Published : March 08, 2017 Abstract Para-aortic lymph node (PALN) dissection is optional and controversial in patients with stage IB1-IIA2 cervical cancer. This retrospective study investigated PALN involvement patterns and evaluated preoperative clinical factors. A total of 723 consecutive FIGO stage IB1-IIA2 cervical cancer patients were included in the study. All patients underwent radical hysterectomy/radical trachelectomy, pelvic lymph node dissection, and PALN dissection. PALN metastasis was found in 101 (14.0%) patients, and the positive PALN rates of stage IB1, IB2, IIA1, and IIA2 were 8.4%, 11.1%, 17.2% and 21.7%, respectively. A multivariate model suggested age > 46 years (OR: 1.67, 95% confidence interval (CI): 1.08-2.58), tumor size > 3.5 cm (OR: 1.79, 95% CI: 1.12-2.87), and FIGO stage IIA ( vs . IB) (OR: 1.97, 95% CI: 1.25-3.11) all positively correlated with PALN metastasis. When squamous cervical cancer cases were categorically analyzed, a multivariate model indicated age > 46 years (OR: 1.67, 95% CI: 1.00-2.80), FIGO stage IIA ( vs . IB) (OR: 1.76, 95% CI: 1.02-3.02), and squamous cell carcinoma antigen (SCCA) > 6.5 ng/ml (OR: 5.20, 95% CI: 3.07-8.81) all positively correlated with PALN metastasis. Age, tumor size, and FIGO stage correlated with PALN metastasis in cervical cancer, while age, FIGO stage, and SCCA level were predictive in squamous cell carcinoma.