Distribution of pelvic lymph nodes as well as preoperative and surgical pathologic factors associated with nodal metastases in women with cervical cancer

We sought to evaluate the distribution pattern of lymph node (LN) metastasis and to indentify preoperative and surgical pathologic factors, which predict positive lymph nodes in patients with cervical carcinoma treated with radical hysterectomy and lymph node dissection (RHND). 365 patients with cervical carcinoma treated by RHND at a single cancer center from 1995 to 2005 were included. 87 patients were found to be with positive lymph nodes. Univariate analysis showed factors impacting node metastasis were FIGO stage, histological type, serum level of squamous cell carcinoma antigen (SCC-Ag) before treatment, preoperative radiotherapy, invasive depth of vaginal portion of the cervix and cervical canal. In a multivariate analysis, FIGO stage, SCC-Ag and the invasive depth of cervical canal were the stronger predictors of positive pelvic lymph nodes. In receiver-operating characteristics (ROC) curves analysis, the “best” cutoff of SCC-Ag was 2.85 ng/mL. The 5-year survival time of patients with positive lymph node was relatively shorter compared with the negative ones (94±1% vs. 67±5%, P-value <0.001). Patients with lymph node (including abdominal aorta or common iliac lymph node metastasis) group had poorer prognosis compared with pelvic lymph node (excluding common iliac lymph node metastasis) group (61±16% vs. 69±6% P<0.001). For patients with cervical carcinoma treated with RHND, FIGO stage, SCC-Ag and the invasive depth of cervical canal emerged to be the most significant predictors of positive lymph nodes. The “best” cutoff of SCC-Ag was 2.85 ng/mL and its real value needs further study.