Related Risk Factors Of Para-aortic Lymph Node Metastases In Early Stages Cervical Carcinoma:A Preliminary Study

Objective:The purpose of the current study was to investigate the incidence and risk factors of para-aortic lymph node.(PALN)metastasis in early cervical carcinomas,as well as the utilization of PALN dissection in those patients.Method:From 2007 to 2014,a total of 423 consecutive patients with stages ? B1 to ?B cervical cancer who underwent radical hysterectomy,pelvic lymphadenectomy,and para-aortic lymph nodes dissection at Affiliated Cancer Hospital of Guangxi Medical University were investigated for risk factors of para-aortic lymph nodes metastasis using univariate and multiple analyses.The interests of imaging and intraoperative exploration for diagnosing para-aortic lymph nodes metastasis were evaluated compared with histological results.Results:The incidence of para-aortic lymph nodes metastases were 2.2%and 7.7%in stages ?B1 and ?A1,and stages ?B2,?A2 and ?B,respectively.There was no significant difference in the incidence of PALN metastasis among ages,body mass index(BMI),tumor sizes,histological types,histology differentiation,lymph vascular space invasion(LVSI)and cervical stromal invasion.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 analysis revealed that upper canal invasion correlated significantly with para-aortic lymph nodes metastasis(OR=2.662,95%CI:1.047-6.769).No statistic difference was found between patients with negative pelvic lymph node and single positive pelvic lymph node,but multiple(n?2)positive pelvic lymph node significant increased risk of para-aortic lymph nodes metastasis(OR=31.492,95%CI:8.895?111.496).Patients with unilateral PLN metastasis had a 6-fold higher risk of PALN metastases than those without PLN metastasis(OR=6.036,95%CI:1.303?27.968,p=0.022),while risk increased up to 50-fold in patients who had bilateral PLN metastasis(OR=50.433,95%CI:13.765?184.778,p<0.001).The sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of imaging and intraoperative exploration for PALN metastases were 36%and 68%,98.7%and 73.6%,64.3%and 13.9%,96.1%and 97.3%,respectively.There was no significant difference of PALN metastases between neoadjuvant chemotherapy group and non-neoadjuvant chemotherapy group.Conclusion: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 at the absence of risk factors or suspicious positive lymph node by image in stages ? B to ?B cervical carcinoma.The indication of PALN dissection at presence of enlarged PALN should be reconsidered.Neoadjuvant chemotherapy may not impact the PALN metastases.