Risk factors and prognosis of IB-IIB cervical carcinoma with common iliac lymph node metastasis

Abstract

BACKGROUND AND OBJECTIVE: Pelvic lymph node metastasis is an important prognostic factor of cervical cancer. The prognosis of cervical cancer patients with common iliac lymph node metastasis is poor, but few systematic studies have been reported. This study was to investigate the characteristics, risk, treatment and prognosis of stage IB-IIB cervical carcinoma patients with common iliac lymph node metastasis. METHODS: A total of 960 patients with cervical cancer receiving radical hysterectomy and bilateral pelvic lymphadenectomy were selected from the hospitalized patients in the Cancer Center of Sun Yat-sen University between January 1995 and December 2005, and analyzed retrospectively. RESULTS: Of the 960 patients, 288 (30.0%) had pelvic lymph node metastasis, and 45 (4.7%) had positive common iliac lymph node. The 5-year overall survival rate (OS) of patients with common iliac lymph node metastasis was 46.1%, and 67.5% in patients with other pelvic lymph node metastasis (P < 0.05). Univariate analysis showed that clinical stage, serum level of squamous cell carcinoma antigen (SCC-Ag) > 4 microg/L before treatment, depth of cervical invasion > or =2/3 and positive parametrial margin were associated with common iliac lymph node metastasis (P < 0.05). Patients with > or =3 pelvic lymph node metastasis (excluding common iliac lymph node) or recurrence had poor prognosis (P < 0.05). Factors predictive of common iliac lymph node metastasis on Logistic forward regression were SCC-Ag > 4 microg/L (P = 0.026, OR = 2.303) before treatment and positive parametrial margin (P = 0.045, OR = 2.634). CONCLUSIONS: Cervical cancer patients with common iliac lymph node metastasis had poorer prognosis compared with patients with other pelvic lymph node metastasis. SCC-Ag >4 microg/L before treatment and positive parametrial margin were the independent predictive factors for common iliac lymph node metastasis of cervical carcinoma. Pelvic lymph node metastasis (excluding common iliac lymph node) > or = 3 or recurrence was prognostic factors for patients with common iliac lymph node metastasis.