More knowledge is required to set up a standard of a more patient oriented and risk-adapted treatment plan. The histology, tumor size and other risk factors of stage IB1 cervical cancer vary significantly and their influences on the lymphatic tumor spread are rarely known. It is not clear how often lymph node metastases occur in different locations and which lymph nodes must be treated to completely cure all nodal metastatic deposits. The precise pattern of lymphatic tumor spread of the early-stage cervical cancer is unknown. Limiting the area of the treatment can reduce the treatment-related toxicities. The common side effects related to the chemoradiotherapy of the total pelvic lymphatic system are lymphoedema and gastrointestinal toxicities. Regardless of the low risk of lymph node metastasis, the whole pelvic chemoradiotherapy is often recommended. The incidence of lymph node metastasis in patients with stage IB1 cervical cancer has been reported to be 13–22%. Individual treatment could be considered for the selected low-risk patients who have smaller tumors and obesity and lack of the parametrial invasion or LVSI. The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. Tumor size above 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion were shown to be significantly correlated with the higher risk of lymphatic metastasis, while obesity (BMI ≥ 25) was independently negatively associated with lymphatic metastases. The incidence of lymphatic spread to different anatomic sites ranged from 0% (presacral) to 30.92% (obturator nodes). Nodal metastases were present in 44 patients (15.22%). Totally 8314 lymph nodes were analyzed with the average number of 31.88 ± 10.34 (Mean ± SD) lymph nodes per patient. Lymph nodes removed from 7 well-defined anatomical locations as well as other tissues were examined histopathologically, and typed, graded, and staged according to the WHO/IARC classification. All patients underwent laparoscopic radical hysterectomy (Querleu and Morrow type C2) and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy (level 2 or level 3 according to Querleu and Morrow) from October 2014 to December 2017. MethodsĪ total of 289 patients with cervical cancer of stage IB1, according to FIGO 2009, were retrospectively analyzed. In the present study we evaluated the distribution of nodal metastases in stage IB1 cervical cancer to explore the possibilities for tailoring cancer treatment. However, the precise pattern of lymphatic tumor spread in cervical cancer is unknown. Systematic pelvic lymphadenectomy or whole pelvic irradiation is recommended for the patients with stage IB1 cervical cancer.
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