Prognostic factors for and pattern of lymph-node involvement in patients with operable cervical cancer

  • P. WidschwendterEmail author
  • W. Janni
  • C. Scholz
  • A. De Gregorio
  • N. De Gregorio
  • T W P Friedl
Gynecologic Oncology



Lymph node metastases significantly worsen the prognosis in cervical carcinoma. Risk factors—pathological and patient related—could select patients at high risk for lymph node involvement.


This retrospective analysis was performed by analyzing data from patients with cervical carcinoma treated between 2000 and 2017 at the Department of Obstetrics and Gynecology of the University Hospital Ulm.


In total, 261 patients with cervical carcinoma (International Federation of Gynecology and Obstetrics (FIGO) stage IA–IIB) and lymphadenectomy with at least 10 removed lymph nodes were available for analysis. Overall, 86 (33.0%) patients had lymph node metastases; 73 patients had pelvic lymph node metastases only and 13 patients had both pelvic and paraaortic lymph node metastases. Lymph node metastases were found most often in the region of the external iliac artery and obturator fossa, with 57.0% and 54.7% of all 86 node-positive patients, respectively. Univariable analyses showed that presence of lymph node metastases was significantly associated with both preoperative FIGO stage (p = 0.001) and final pathological tumor stage (p < 0.001), status of resection margin (p = 0.002), lymphovascular space invasion (LVSI), (p < 0.001) and vascular space invasion, (p < 0.001). In a multivariable logistic regression model with presence of lymph node metastases (yes/no) as binary response variable, only LVSI (p < 0.001) and body mass index (BMI), (p = 0.035) remained as significant independent predictors of lymph node involvement. Subgroup analyses showed that LVSI was a significant predictive factor for lymph node involvement in patients with a preoperatively assessed FIGO stage < IIB (p < 0.001), but not for patients with a preoperatively assessed FIGO stage ≥ IIB (p = 0.122).


The risk factor LVSI should play an important role in deciding whether an individualized therapy concept is based on escalating or deescalating treatment. In future, the sentinel concept could reduce morbidity and at the same time provide an important prognostic assessment for a subset of cervical cancer patients.


Cervical cancer Lymph node Prognostic factor Pattern LVSI 


Author’s contribution

PW: Protocol/project development, Data collection or management, Data analysis, Manuscript writing/editing. WJ: Protocol/project development, Manuscript editing. CS: Manuscript editing, Protocol development. ADG: Data collection, Manuscript editing. NDG: Data collection, Manuscript editing. TWPF: Data analysis, Statistics, Manuscript editing.


No funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This retrospective analysis was approved by the ethic committee of the university of Ulm, Germany. Number 133/16.

Informed consent

Informed consent was not possible in this study due to retrospective data collection.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gynecology and ObstetricsUniversity Hospital UlmUlmGermany

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