Analysis Of The Difference Between Clinical And Surgical Pathological Stages And Risk Factors For Lymph Node Metastasis In 245 Cases Of Cervical Cancer

Objective Based on the latest FIGO staging criteria for cervical cancer in2018,the differences between clinical staging and surgical pathological staging of245 patients with cervical cancer were studied to further analyze the risk factors that may be related to lymph node metastasis,and to provide reference for the evaluation of clinical staging and treatment of cervical cancer in clinical work.Methods By reviewing the cases diagnosed with cervical cancer from 01/01/2018 to 12/31/2021at Minda Hospital of Hubei Minzu University for Nationalities,all of which were treated surgically in our hospital,factors such as age,tumor size,preoperative clinical staging,pathological type and differentiation,parametrial infiltration,choroidal infiltration,depth of interstitial infiltration,and lymph node positivity were collected from patients.Preoperative clinical staging according to the 2018FIGO staging criteria for cervical cancer（with staging correction for cases not using the 2018 FIGO staging）was compared with postoperative pathological staging to further explore possible risk factors associated with lymph node metastasis.Results（1）Compared with postoperative pathological staging,clinical staging was IA1 stage,too low in 6 cases（25 %）,staging matched in 18 cases（75 %）,IA2 stage was too low in 1 case,staging matched in 0 cases,IB1 stage was too low in 3 cases（5.45 %）,staging matched in 52 cases（94.55 %）,IB2 stage was too low in 6 cases（14.29 %）,staging matched in 36 cases（85.71%）,4 cases（20%）were under-staged in stage IB3,16 cases（80%）were stage-compatible,3 cases（4.29%）were over-staged in stage IIA1,10 cases（14.29%）were under-staged,57 cases（81.43%）were stage-compatible,1 case（3.03%）was over-staged in stage IIA2,10 cases（30.30%）were under-staged,and The staging matched in 22 cases（66.67%）.The clinical stages were IA1,IB1,IB2,IB3,IIA1,and IIA2,and the compliance rates were 75.00%,94.55%,85.71%,80.00%,81.43%,and 66.67%,respectively,with the highest compliance rate for IB1,followed by IB2,IIA1,IB3,IA1,and IIA2.the lowest,with significant differences between the groups（χ2=16.966,P=0.022<0.05）.With the increase of clinical stage of cervical cancer,the compliance rate between FIGO stage and surgical pathological stage of cervical cancer gradually decreased.（2）FIGO staging and surgical pathological staging were significantly correlated(（r=0.876,P<0.05）.The FIGO staging of cervical cancer was most likely the same as the postoperative pathological staging.This shows that the preoperative accurate determination of clinical stage has some reference value for postoperative pathological stage.（3）There were 25 cases of stage IA with no lymph node metastasis,55 cases of stage IB1 with 1 case（1.82%）of lymph node metastasis found,42 cases of stage IB2 with 3 cases（7.14%）of lymph node metastasis found,a total of 20 cases of stage IB3 with 3 cases（15%）of lymph node metastasis found,a total of 70 cases of stage IIA1 with 10 cases（14.3%）of lymph node metastasis found,and There were 33 cases in IIA2,and 9 cases（27.3%）had lymph node metastasis,which showed that the rate of lymph node metastasis showed an increasing trend with the increase of clinical stage.（4）Univariate analysis showed that the pathological type of cervical cancer,patients’ age,cutting edge status and differentiation degree were not related to whether lymph node metastasis occurred,and the difference was not statistically significant（P > 0.05）,and the factors affecting lymph node metastasis were related to whether the parametrial tissue was infiltrated,whether there was cancer thrombus in the vasculature,the preoperative clinical stage of cervical cancer,the length of tumor diameter and the depth of myocardial infiltration（P< 0.01）.When multifactorial analysis was done using a logistic regression model,the results showed that the presence of infiltration of parametrial tissue（P< 0.05,OR=4.603）,the presence of tumor thrombus in the vasculature（P<0.001,OR=8.522）,and the length of tumor diameter（P<0.05,OR=1.420）were independent risk factors for lymph node metastasis（P<0.05）.Conclusion（1）According to the latest FIGO staging criteria for cervical cancer in2018,the overall compliance rate of clinical staging of patients with cervical cancer in our hospital was high（82.04%）,but there were still some clinical staging inaccuracies,accounting for about 17.96%,of which 1.63% were overstaged and16.33% were understaged due to clinical staging of cervical cancer patients with lymph node metastasis found in postoperative pathological examination escalation,and the compliance rate between clinical staging and surgical pathological staging is related to the clinical staging level,and the higher the FIGO staging,the lower the compliance rate between them,but the incidence of lymph node metastasis will increase.Therefore,it is necessary to focus on the lymph node situation when preoperative clinical staging is performed.（2）Parametrial tissue infiltration,clinical staging,intraventricular cancer thrombus,diameter of tumor and depth of muscle infiltration are risk factors for lymph node metastasis,among which,parametrial tissue infiltration,presence of tumor thrombus in the vasculature and large tumor lesions are independent risk factors for lymph node metastasis,and clinically,we can focus on detecting lymph node status and predicting the possibility of lymph node metastasis in advance based on relevant examination and pathological results,which can,to a certain extent To a certain extent,it can improve the accuracy of clinical staging and provide reference for the development of individualized treatment plan.