Para-aortic lymph node recurrence in cervical cancer patients

Objective: The primary aim of the study was to analyze incidence and risk factors for para-aortic lymph node recurrence (PALNR) in IA1 to IB2 International Federation of Gynecology and Obstetrics (FIGO) 2009 stage cervical cancer patients who were initially treated with radical hysterectomy and pelvic lymph node dissection. Methods: We conducted a retrospective analysis of stage I cervical cancer patients who had been treated with radical hysterectomy and pelvic lymphadenectomy with or without adjuvant therapy. We identified 242 patients, of whom 58 (24%) were diagnosed with PALNR by imaging studies. Results: The group of patients with PALNR had higher tumor grades (G1: 2 patients (3.4%); G2: 44 (75.9%) and G3: 12 (20.7%) vs G1: 48 (26.1%), G2: 112 (60.9%) and G3: 24 (13.0%); p = 0.001), more advanced age (median; range 54 (29-78) vs 49 (23- 76); p = 0.02) and fewer pelvic lymph nodes harvested during primary surgery (median; range 11 (3-27) vs 14 (2-40); p = 0.002) when compared to patients without PALNR. The prognosis of patients with PALNR was significantly worse when compared to patients without PALNR (5-year overall survival of 72% vs 87%, p = 0.01). 5-year overall survival following PALNR was 69%. We found no association between PALNR and tumor stage, tumor size, the presence of pelvic lymph node metastases or the histopathologic type of the tumor. Conclusion: We conclude that cervical cancer patients with high tumor grade, older age, and low number of pelvic lymph nodes harvested during initial surgery are at higher risk of PALNR.