Assessment of retroperitoneal lymph node status in locally advanced cervical cancer

• Published in: BMC cancer Vol. 21; no. 1; pp. 484 - 9
• Main Authors: Li, Wei, Xiong, Li, Zhu, Qiaoling, Lu, Hong, Zhong, Meiling, Liang, Meirong, Jiang, Wei, Wang, Yanan, Cheng, Wei
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01-05-2021; BioMed Central; BMC
• Subjects: Abdomen; Adult; Aged; Antibodies; Antigens; Antigens, Neoplasm - blood; Aorta; Area Under Curve; Cancer therapies; Carcinoma - blood; Carcinoma - diagnostic imaging; Carcinoma - pathology; Carcinoma - therapy; Carcinoma, Squamous Cell - blood; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Cervical cancer; Cervical neoplasm; Chemoradiotherapy; Chemotherapy; Childrens health; Computed tomography; Computed tomography (CT); Coronary vessels; Correlation analysis; Enzymes; Female; Humans; Laparoscopy; Lymph Node Excision - methods; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - immunology; Lymph Nodes - pathology; Lymphatic metastasis; Lymphatic Metastasis - pathology; Lymphatic system; Magnetic resonance imaging; Maternal & child health; Medical prognosis; Metastases; Metastasis; Middle Aged; Pathology; Patients; Radiation therapy; Radiotherapy, Intensity-Modulated; Retroperitoneal lymph node; Retroperitoneal Space; Risk Factors; Sensitivity and Specificity; Serpins - blood; Squamous cell carcinoma; Squamous cell carcinoma antigen (SCC-Ag); Statistics; Surgical outcomes; Tomography, Spiral Computed; Uterine Cervical Neoplasms - blood; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - therapy; Young Adult; China; Computed tomography (CT); Squamous cell carcinoma antigen (SCC-Ag); Retroperitoneal lymph node; Cervical neoplasm
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-021-08208-6

The assessment of retroperitoneal lymph node status in patients with locally advanced cervical cancer is still a problem. This study aimed to explore the choice of these assessment methods.
Laparoscopic retroperitoneal lymphadenectomy was performed in 96 patients with advanced cervical cancer. The positive rates of lymph node metastasis were analyzed. The values of computed tomography lymph node minimum axial diameter (MAD) and squamous cell carcinoma antigen (SCC-Ag), and their combination in predicting retroperitoneal lymph node metastasis were compared. High-risk factors for common iliac lymph node (CILN) and/or para-aortic lymph node (PALN) metastasis were analyzed.
The lymph node metastasis rate was 62.50% and the CILN and/or PALN metastasis rate was 31.25%. Overall, 96 patients had 172 visible lymph nodes. The positive rate of lymph node metastasis was significantly higher in the MAD ≥1.0 cm group (83.33%) than in the 0.5 cm ≤ MAD < 1.0 cm group (26.82%). The critical values of MAD and SCC-Ag in determining lymph node metastasis were 1.0 cm and 5.2 ng/mL, respectively. The accuracy, specificity, and Youden index of MAD ≥1.0 cm combined with SCC-Ag ≥ 5.2 ng/mL for evaluating lymph node metastasis were 75.71%, 100%, and 0.59, respectively, and were significantly different from the values for the MAD ≥1.0 cm (72.09%, 80.56%, and 0.47, respectively) and SCC-Ag ≥ 5.2 ng/mL (71.43%, 68.97%, and 0.42, respectively) groups. Correlation analysis showed that non-squamous cell carcinoma, pelvic lymph node (PLN) MAD ≥1.0 cm plus number ≥ 2, and 1 PLN MAD ≥1.0 cm with CILN and/or PALN MAD 0.5-1.0 cm were risk factors for CILN and/or PALN metastasis.
Patients with MAD ≥1.0 cm and SCC-Ag ≥ 5.2 ng/mL, as well as high risk factors for CILN and/or PALN metastasis, should undergo resection of enlarged lymph nodes below the common iliac gland and lymphadenectomy of CILN/PALN to reduce tumor burden and to clarify lymph node metastasis status for accurate guidance in follow-up treatment. Patients with MAD < 1.0 cm and SCC-Ag < 5.2 ng/mL may be treated with chemoradiotherapy directly based on imaging, given the low lymph node metastasis rate.