Study On The Relationship Between The Size Of Cervical Lesions And The Pelvic Lymph Node Metastasis And The Clinical Prognosis

Objective:To study the correlation between the size of cervical lesions and pelvic lymph node metastasis,and to analyze the prognosis of different lesions.Appropriate treatment for different lesion size are discussed.Methods:Cervical cancers(FIGO stage ?bl-?a2)who operated in Maternity hospital of Dalian from January 2008-April 2011 with complete clinical data were collected retrospectively.A total of 172 patients were included in this study.Among them,neoadjuvant chemotherapy was performed in 29 patients(this study should be excluded).The patients were 21-71 years old and the median age was 49 years.According to the 2009 International Federation of Gynecology and Obstetrics(FIGO)staging criteria:99 patients with stage ?,44 patients with stage II;Pathological types:125 patients with squamous cell carcinoma,13 patients with adenocarcinoma,3patients with adenosquamous carcinoma,and 2 patients with other pathological type.23 patients with tumor size larger than 4cm,120 cases were less than4cm;Cell differentiation:24 cases were highly differentiated,moderately differentiated in 50 cases,and poorly differentiated in 69 cases.There were 49 patients with lymph-vascular space invasion,and 94 patients without lymph-vascular space invasion.4 patients with positive parametrial invasion,139 cases with negative parametrial invasion;There were 36 cases with pelvic lymph node metastasis and no metastasis in 107 cases.All cases were confirmed by pathology,and were examined by a competent pathologist.143 patients were treated with radical hysterectomy and pelvic lymph node dissection.According to the risk factors,adjuvant radiotherapy or combined chemoradiotherapy was performed.By postoperative pathological data correlation analysis to explore the risk factors of pelvic lymph node metastasis.The correlation between tumor size and pelvic lymph node metastasis was studied by single factor chi square test.Then,the size of cervical cancer was further stratified to explore the difference of lymph node metastasis rate and the relationship between the size of different lesions and lymphatic metastasis.11 patients with tumor sizelcm,37 patients with tumor size 1.1cm-2.0cm,33 patients with tumor size 2.1-3.0cm,39 patients with tumor size 3.1-4.Ocm,23 patients with tumor size>4cm.143 postoperative patients were followed-up by tumor outpatient clinic visits,phone calls,visits.The follow-up deadline is April 2016.124 cases were followed up,and 19 cases were lost.When the cutoff value was 4cm,109 patients with tumor size ? 4cm,23 cases with lymph node metastasis;15 patients with tumor size>4cm,6 cases with lymph node metastasis.When the cutoff value was 2cm,39 patients with tumor size ? 2cm,5 cases with lymph node metastasis;85 patients with tumor size>2cm,24 cases with lymph node metastasis.The patients were followed up to compare the prognosis of the patients with different size,and to explore the best individualized treatment plan.Results:(1)Through the single factor analysis showed that the influence of metastasis pelvic lymph node of cervical carcinoma may be related to the FIGO staging,lymph vascular space invasion,parametrial invasion and the size of lesions(P<0.05).Pathological types and differentiation degree of tumor cells may be not apparently related to metastasis pelvic lymphnode(P>0.05).(2)Through further stratification of lesion size,we find that metastasis rate is 9.09%for size ?1cm,metastasis rate is 13.51%for size 1.1-2.0cm,metastasis rate is 21.21%for size 2.1-3.0cm,metastasis rate is 30.77%for size 3.1-4.0cm,metastasis rate is 47.83%for size>4cm.(3)The 5-year disease-free survival(DFS)and overall survival(OS)are compared between size ? 4cm and size>4cm,The 5-year OS was 93%and the 5-year DFS was 92%for size ?4cm.The 5-year OS was 75%and the 5-year DFS was 73%for size>4cm.The difference was statistically significant(P<0.05).There was no significant difference in the 5-year OS and DFS between the two groups with the lesion size 2cm as the limit.Conclusion:(1)There was a positive correlation between the incidence of pelvic lymph node metastasis and lymph vascular space invasion,parametrial invasion,the FIGO staging,the size of lesions.(2)The greater the focus of cervical cancer,the greater the risk of lymph node metastasis.(3)The lesions ? 4cm in patients with pelvic lymph node metastasis rate and 5-year OS,5-year DFS is better than the lesions>4cm.