Risk factors of para-aortic lymph node metastasis in stages IB, IIA and IIB cervical carcinoma

Objective: The purpose of the present study was to investigate the incidence and risk factors of para-aortic lymph node metastasis in stages IB, IIA and IIB cervical carcinoma and provide the basis for para-aortic lymph node dissection. Method: Four hundred and twenty-three patients with stages IB, IIA and IIB cervical cancer who had undergone radical hysterectomy, pelvic lymphadenectomy, and para-aortic lymph node dissection were investigated for risk factors of para-aortic lymph node metastasis using univariate and multiple analyses. The efficacy of imaging and intraoperative exploration for diagnosing para-aortic lymph nodes metastasis was evaluated compared with histological results. Results: The incidence of para-aortic lymph node metastases was 2.2% and 7.7% in stages IB1 and IIA1, and stages IB2, IIA2 and IIB, respectively. Clinical stages, parametrial invasion, upper canal invasion, pelvic lymph node metastasis, and common iliac lymph node metastasis were related to para-aortic lymph nodes metastasis analyzed by univariate analyses (P<0.05). Multiple analyses revealed that upper canal invasion correlated significantly with para-aortic lymph nodes metastasis (OR=2.662, 95% CI: 1.047-6.769). No statistical difference was found between patients with a negative pelvic lymph node and a single positive pelvic lymph node, but multiple (n≥2) positive pelvic lymph nodes significantly increased the risk of para-aortic lymph node metastasis (OR=31.492, 95% CI: 8.895~111.496). The sensitivity, specificity, positive predictive value, and negative predictive value of imaging and intraoperative exploration for diagnosis of PALN metastases were 36% and 68%, 98.7% and 73.6%, 64.3% and 13.9%, 96.1% and 97.3%, respectively. Conclusions: Upper canal invasion, multiple PLN metastases, and common iliac lymph node metastasis may be the significant risk factors of PALN metastasis. Because of the low incidence of PALN metastasis, routine para-aortic lymph node dissection may be unnecessary in the absence of any risk factors or of suspicious positive lymph node in images taken of stages IB, IIA and IIB cervical carcinoma.