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Para-aortic lymph node involvement revisited in the light of the revised 2018 FIGO staging system for cervical cancer

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

This dual-institutional, retrospective study aimed to determine the clinicopathological risk factors for para-aortic lymph node (LN) metastasis among women who underwent radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy for 2009 FIGO stage IB1-IIA2 cervical cancer.

Methods

Institutional cervical cancer databases of two high-volume gynecologic cancer centers in Ankara, Turkey were retrospectively analyzed. Women with 2009 FIGO stage IB1-IIA2 cervical cancer that had undergone radical hysterectomy with pelvic and para-aortic lymphadenectomy between January 2006 and December 2018 were included in the study. Patient data were analyzed with respect to para-aortic LN involvement and all potential clinicopathological risk factors for para-aortic LN metastasis were investigated.

Results

A total of 522 women met the inclusion criteria. Pelvic LN metastasis was detected in 190 patients (36.4%), para-aortic LN metastasis in 48 patients (9.2%), isolated para-aortic LN metastasis in 4 (0.8%), and both pelvic and para-aortic LN metastasis in 44 (8.4%) women, respectively. The independent risk factors identified for para-aortic LN involvement included parametrial invasion (odds ratio [OR]: 3.57, 95% confidence interval [CI]: 1.65–7.72; p = 0.001), metastasized pelvic LN size > 1 cm (OR: 4.51, 95% CI: 1.75–11.64; p = 0.002), multiple pelvic LN metastases (OR: 3.83, 95% CI: 1.46–10.01; p = 0.006), and common iliac LN metastasis (OR: 2.97, 95% CI: 1.01–8.68; p = 0.04). A total of 196 (37.5%) patients exhibited at least one risk factor for para-aortic nodal disease.

Conclusion

Parametrial invasion, metastasized pelvic LN size > 1 cm, multiple pelvic LN metastases, and common iliac LN metastasis seem to be independent predictors of para-aortic LN involvement.

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Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey

    Ali Ayhan & Esra Kuşçu

  2. Department of Gynecologic Oncology, Zekai Tahir Burak Women’s Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Talatpaşa Bulvarı, 06230, Ankara, Turkey

    Koray Aslan, Murat Öz & Mehmet Mutlu Meydanli

  3. Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey

    Yusuf Aytaç Tohma

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  1. Ali Ayhan
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  3. Murat Öz
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Contributions

AA: conceptualized and designed the study, prepared the draft manuscript. MMM: conceptualized and designed the study, analyzed and interpreted the data, prepared the draft manuscript. KA: collected the data, performed statistical analyses, edited and reviewed the manuscript. YAT: collected the data, edited and reviewed the manuscript. EK: controlled the quality of the data, analyzed and interpreted the data, edited and reviewed the manuscript. MÖ: controlled the quality of the data, analyzed and interpreted the data, performed statistical analyses, edited and reviewed the manuscript. All co-authors revised the manuscript critically and approved the final version to be published. MÖ accepts full responsibility for the work and/or the conduct of the study, had access to the data, and oversaw the decision to publish.

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Correspondence to Murat Öz.

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Ayhan, A., Aslan, K., Öz, M. et al. Para-aortic lymph node involvement revisited in the light of the revised 2018 FIGO staging system for cervical cancer. Arch Gynecol Obstet 300, 675–682 (2019). https://doi.org/10.1007/s00404-019-05232-7

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