title: Distribution pattern of lymph node metastases and its implication in individualized radiotherapeutic clinical target volume delineation of regional lymph nodes in patients with stage IA to IIA cervical cancer.
abstract: BACKGROUND
  To study the distribution pattern of lymph node metastases of stage IA to IIA cervical cancer and to clarify the individualized clinical target volume delineation of regional lymph nodes (CTVn).
  
  
  METHODS
  A total of 665 cases with International Federation Gynecology and Obstetrics stage IA to IIA cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively reviewed. The clinicopathological factors related to lymph node metastases were analyzed using logistic regression analysis.
  
  
  RESULTS
  Pelvic lymph node metastases were found in 168 of 665 patients resulting in a metastasis rate of 25.3%. Binary logistic regression analysis showed that age, lymph vascular space involvement, and deep stromal invasion statistically influenced pelvic lymph node metastases (p = 0.017, < 0.001, < 0.001, respectively). Pathological morphology type, lymph node metastases of the obturator, the external iliac and internal iliac, and the para-aortic had a strong influence on lymph node metastases of the common iliac (p = 0.022, 0.003, < 0.001, 0.009, respectively). Tumor size and lymph node metastases of the common iliac were significantly related to lymph node metastases of the para-aortic (p = 0.045, < 0.001, respectively). Lymph node metastases of the obturator, the external iliac and internal iliac were strongly correlated to lymph node metastases of the circumflex iliac node distal to the external iliac node (CINDEIN; p = 0.027, 0.024, respectively).
  
  
  CONCLUSIONS
  Factors related to lymph node metastases should be comprehensively considered to design and tailor CTVn for radiotherapy of cervical cancer. Selective regional irradiation including the correlated lymphatic drainage regions should be performed.
authors.affiliation: Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China. xinglan_li0225@163.com.|School of Medicine and Life Sciences, University of Jinan - Shandong Academy of Medical Sciences, 106 Jiwei Road, Jinan, 250022, Shandong Province, People's Republic of China. xinglan_li0225@163.com.
authors.forename: Xinglan
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China. yk_688@163.com.
authors.forename: Yueju
authors.initials: Y
authors.lastname: Yin
authors.affiliation: Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China. shengxiugui@163.com.
authors.forename: Xuigui
authors.initials: X
authors.lastname: Sheng
authors.affiliation: Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China. 530511075@qq.com.
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Han
authors.affiliation: Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China. sunli766@163.com.
authors.forename: Li
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China. sdacfl@163.com.
authors.forename: Chunhua
authors.initials: C
authors.lastname: Lu
authors.affiliation: Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China. 505758653@qq.com.|School of Medicine and Life Sciences, University of Jinan - Shandong Academy of Medical Sciences, 106 Jiwei Road, Jinan, 250022, Shandong Province, People's Republic of China. 505758653@qq.com.
authors.forename: Xiang
authors.initials: X
authors.lastname: Wang
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy / Q000556:secondary*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000532:radiotherapy / Q000556:secondary*; D057285:Precision Medicine; D011379:Prognosis; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D055815:Young Adult