title: Can pelvic lymphadenectomy be omitted in patients with stage IA2, IB1, and IIA1 squamous cell cervical cancer?
abstract: OBJECTIVE
  This study aimed to identify the surgical-pathologic risk factors of lymph node metastasis (LNM) in patients with early stage squamous cell cervical cancer and to evaluate the potential efficacy of omitting pelvic lymphadenectomy.
  
  
  METHODS
  A total of 276 patients with stage IA2, IB1, and IIA1 squamous cell cervical cancer receiving primary radical hysterectomy with pelvic lymphadenectomy were included in this study.
  
  
  RESULTS
  The incidences of LNM in patients with stage IA2, IB1, and IIA1 squamous cell cervical cancer were 0 % (0/8), 17.4 % (36/207), and 29.5 % (18/61), respectively. The most common location of LNM was the obturator lymph node. Human papilloma virus 16 subtype was the most common infection in early stage squamous cell cervical cancer. Univariate analysis revealed that squamous cell carcinoma antigen (SCCAg) greater than 1.5 μg/L (p < 0.001), tumor size greater than 2 cm (p < 0.001), tumor size greater than 3 cm (p < 0.001), depth of stromal invasion (p < 0.001) and lymphovascular invasion (p < 0.001) were associated with LNM. Logistic regression analysis revealed that depth of stromal invasion {model 1 [p = 0.006; odds ratio (OR) 2.161; 95 % confidence interval (CI) 1.251-3.734], model 2 [p = 0.002; OR 2.344; 95 % CI 1.337-3.989]}, lymphovascular invasion [model 1 (p = 0.004; OR 2.967; 95 % CI 1.411-6.237), model 2 (p = 0.004; OR 2.978; 95 % CI 1.421-6.243)], and SCCAg greater than 1.5 μg/L [model 1 (p = 0.023; OR 2.431; 95 % CI 1.129-5.235), model 2 (p = 0.024; OR 2.418; 95 % CI 1.125-5.194)] were independently associated with LNM.
  
  
  CONCLUSIONS
  Pelvic lymphadenectomy may be omitted in patients with SCCAg lower than 1.5 μg/L, superficial stromal invasion and without lymphovascular invasion in stage IA2, IB1, IIA1 squamous cell cervical cancer.
authors.affiliation: Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China.|Xiamen Cancer Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003 People's Republic of China.
authors.forename: Yaxian
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China.
authors.forename: Tingting
authors.initials: T
authors.lastname: Yao
authors.affiliation: Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China.
authors.forename: Jin
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Xiamen Cancer Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003 People's Republic of China.
authors.forename: Qionghua
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China.
authors.forename: Zhongqiu
authors.initials: Z
authors.lastname: Lin
keywords: Early stage cervical cancer; Lymph node metastasis; Lymphovascular invasion; Pelvic lymphadenectomy; Squamous cell carcinoma antigen; Stromal invasion