We aimed to investigate the effect of LVSI and lymph involvement on survival in early stage cervical cancer.
Material and Methods: 223 patients with early stage (stage 1a1-1b2) cervical cancer were enrolled to the study retrospectively between 2000 and 2011. Patients were evaluated according to lymphovascular stromal invasion and lymph node status. In addition, patients were divided into groups according to the number of lymph nodes dissected and malignant lymph nodes, and the effects on survival were analyzed by univariate and multivariate analyzes.
Results: Systemic (lymphadenectomy) LND was performed in 168 patients (75.3%) while bilateral pelvic and paraaortic lymph nodes were sampled in 55 (24.6%) patients. While 67 (30%) patients had lymph node metastasis, 156 (70%) patients did not. While LVSI was not seen in 15 (6.7%) of the patients with lymph node involvement, it was seen in 52 (23.3%) (p: 0.001). Isolated paraaortic lymph was seen in 2 (0.8%) patients. The univariate analysis for PFS showed that the risk is highest in LVSI (HR: 4.11 (95% CI: 1.63-10.36 P: 0.003)) and pelvic lymph involvement (HR: 3.75 (95% CI: 1.66-8.45 p: 0.001)). However, in the univariate analysis for OS, when the number of malignant lymph nodes was above 4, it was found to be the highest risk factor with HR: 13.97 (95% CI: 4.74-41.14 p: 0.001). Lymph node metastasis was found to be an independent prognostic risk factor in the multivariate analysis for OS (HR: 2.52 (95% CI: 1.08-5.86 p: 0.031)).
Conclusion: As a conclusion, it has been demonstrated that LVSI is a prognostic risk factor that significantly affects both short and long-term survival, both indirectly and directly, the lymph involvement is of vital importance in early-stage cervical cancer and is an independent prognostic risk factor. In the surgical treatment of early-stage cervical cancer, maximum effort should be made and a great care taken for the number of lymph nodes to be dissected and it should be taken into consideration that as many lymph nodes should be removed as there is no specific number standard.