A Multicenter Study on the Relationship of Tumor Lesion Location with Bilateral Parametrial Involvement and Pelvic Lymph Node Metastasis in Cervical Squamous Cell Carcinoma.

Background: This study aimed to explore the relationship of cervical tumor lesion location (CTLL) with bilateral parametrial involvement (PI) and pelvic lymph node metastasis (LNM).

Methods: The study retrospectively analyzed the clinicopathologic and imaging data of patients with cervical squamous cell carcinoma (SCC) retrieved from multiple centers. According to the CTLL, patients were allocated to three groups: a middle one third group, a unilaterally dominant group, and the entire-region group. Uni- and multivariate logistic regression analyses were performed to explore the preoperative risk factors related to PI and pelvic LNM. The rates of PI and pelvic LNM at the tumor-ipsilateral side and the tumor-contralateral side were compared using the Wilcoxon test.

Results: The study enrolled 776 cases. The CTLL was an important preoperative risk factor for both PI and pelvic LNM. Parametrial involvement occurred solely on the tumor-ipsilateral side (3.57 %) in the unilaterally dominant group, whereas the rate of pelvic LNM on the tumor-ipsilateral side was 11.22 %, significantly higher than on the contralateral side (5.1 %), with no pelvic LNM found on the tumor-contralateral side of patients with tumors smaller than 3.5 cm.

Conclusions: Cervical SCC exhibits the characteristic of more accessible tumor-ipsilateral PI and pelvic LNM. When evaluation by magnetic resonance imaging (MRI) shows that the tumor lesion does not involve the contralateral one third of the cervix, a reduction in the resection scope of the contralateral parametrium can be considered, avoiding resection of the para-aortic lymph nodes, and if the tumor is smaller than 3.5 cm, a reduction in the resection scope of the tumor-contralateral pelvic lymph nodes also can be considered.