Evaluation of prognostic significance in extracapsular spread of pelvic lymph node metastasis in patients with cervical cancer.

Background: Extracapsular spread of lymph node (LN) metastasis has been shown as a negative prognostic factor in cancers of several organs. This study was performed to clarify the prognostic significance of extracapsular spread of pelvic lymph node metastases in patients who underwent radical hysterectomy and pelvic, paraaortic lymphadenectomy for International Federation of Gynecology and Obstetrics (FIGO) Stage I-II cervical carcinoma.

Methods: Ninety-five patients were treated wih radical hysterectomy and pelvic paraaortic lymphadenectomy for Stage I-II cervical carcinoma. Twenty-one cases with positive nodes of the tumor and lymph nodes were reviewed. The describtion of the pattern of metastasis present in the node was focused on: maximal diameter of metastasis was compared with the maximal diameter of the node, the capsular integrity, and the type of immune response. The prognostic significance of extracapsular spread (ECS), maximal diameter of metastasis and the type of immune response of pelvic metastases was evaluated with respect to disease-free survival (DFS), overall survival, and the pattern of disease recurrence.

Results: ECS was seen in 52.4% (11/21) of the cases. The 5-year DFS rate in patients with ECS was significantly lower compared to patients without ECS (63.4% vs 100%; p = 0.03). To assess the independent impact of ECS on overall survival, the multivariate Cox regression model was not significantly different.

Conclusion: From data in our study and those obtained from the literature, the occurence of ECS should be given in the pathology report. Including ECS in the classification of nodal involvement might be helpful in better prognostic discrimination of patients with metastatic lymph nodes.