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Can Pelvic Lymphadenectomy be Omitted in Stage IA2 to IIB Uterine Cervical Cancer?

Togami, Shinichi MD, PhD; Kamio, Masaki MD, PhD; Yanazume, Shintaro MD, PhD; Yoshinaga, Mitsuhiro PhD; MD; Douchi, Tsutomu MD, PhD

International Journal of Gynecological Cancer: July 2014 - Volume 24 - Issue 6 - p 1072–1076
doi: 10.1097/IGC.0000000000000163
Cervical Cancer

Objectives: The aims of this study were to predict pelvic lymph node metastasis in uterine cervical cancer before surgery and to evaluate the potential efficacy of omitting pelvic lymphadenectomy.

Materials and Methods: A total of 163 patients with invasive uterine cervical cancer in FIGO stage IA2 to IIB, all of whom underwent primary radical hysterectomy with pelvic lymphadenectomy, participated in this study.

Results: The incidences of pelvic lymph node metastasis in stage IA2, stage IB1, stage IB2, stage IIA, and stage IIB cervical cancer were 0% (0/12), 17% (13/76), 22% (6/27), 33% (8/24), and 63% (15/24), respectively. A significant difference was observed in overall survival with nodal metastasis status (P < 0.0001). Univariate analysis revealed that parametrial invasion (P < 0.0001), tumor markers (P = 0.0006), tumor size greater than 2 cm (P < 0.0001), tumor size less than 3 cm (P = 0.0009), and tumor size greater than 4 cm (P = 0.0024) were correlated with pelvic lymph node metastasis. However, multivariate analysis revealed that parametrial invasion (P = 0.01; odds ratio, 3.37; 95% confidence interval, 1.31–9.0) and tumor size greater than 2 cm (P = 0.005; odds ratio, 4.93; 95% confidence interval, 1.54–22.01) were independently associated with nodal metastasis.

Conclusions: Pelvic lymphadenectomy may be avoided in patients with negative parametrial invasion and a tumor size less than 2 cm, thereby minimizing postoperative complications.

Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.

Address correspondence and reprint requests to Shinichi Togami, MD, PhD, Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. E-mail: togami@m3.kufm.kagoshima-u.ac.jp.

The authors declare no conflicts of interest.

Received February 4, 2014

Accepted April 1, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.