• Cervical cancer
• lymph node count
• lymph node positive ratio
• lymphadenectomy

• Humans
• Female
• Uterine Cervical Neoplasms/mortality
• Uterine Cervical Neoplasms/pathology
• Uterine Cervical Neoplasms/surgery
• Retrospective Studies
• Middle Aged
• Neoplasm Staging
• SEER Program
• Lymph Nodes/pathology
• China/epidemiology
• Aged
• Lymphatic Metastasis/pathology
• Adult
• United States/epidemiology
• Prognosis
• Proportional Hazards Models
• East Asian People

• Cervical cancer
• Lymph node metastasis
• Lymphadenectomy
• Nomogram
• SEER

• Female
• Humans
• Lymph Node Excision
• Lymph Nodes/pathology
• Lymphatic Metastasis/pathology
• Neoplasm Staging
• Nomograms
• Uterine Cervical Neoplasms/surgery
• Uterine Cervical Neoplasms/pathology
• Multicenter Studies as Topic

• National Natural Science Foundation of China
• Natural Science Foundation of Guangdong province
• Guangdong Basic and Applied Basic Research Foundation-the Regional Joint Fund
• China Postdoctoral Science Foundation

• Female
• Humans
• Adjuvants, Immunologic
• Lymph Node Excision
• Lymph Nodes/surgery
• Lymph Nodes/pathology
• Lymphatic Metastasis/pathology
• Neoplasm Recurrence, Local/pathology
• Neoplasm Staging
• Retrospective Studies
• Sentinel Lymph Node Biopsy
• Uterine Cervical Neoplasms/surgery
• Uterine Cervical Neoplasms/pathology

• Universidad de Navarra

• cause-specific
• cervical cancer
• competing-risks model
• prognostic factors
• sub-distribution

• Carcinoma, Squamous Cell/epidemiology
• Carcinoma, Squamous Cell/therapy
• Female
• Humans
• Incidence
• Neoplasm Staging
• Prognosis
• Proportional Hazards Models
• SEER Program
• Uterine Cervical Neoplasms/diagnosis
• Uterine Cervical Neoplasms/epidemiology
• Uterine Cervical Neoplasms/therapy

We aimed to investigate the association of examined lymph node (ELN) number with lymph node status and long-term survival in FIGO stage IB-IIA cervical squamous cell carcinoma(CSCC) and to determine the minimum number of ELN associated with survival improvement.

Data from the Surveillance, Epidemiology, and End Results Program (SEER) database of FIGO stage IB-IIA CSCC patients undergoing hysterectomy and pelvic lymphadenectomy in 2004-2016 were analyzed to explore the relationship between ELN number and lymph node status and overall survival (OS) by using the multivariable approach. The estimated probability of falsely identifying a patient as node-negative and the hazard ratios (HRs) for each ELN was fitted with a LOWESS smoother, and the structural breakpoints were determined. X-tile software was used to determine the optimal cutoff value for ELNs.

A total of 2627 patients were analyzed. The optimal cutoff value of the ELN number was identified as 7 based on the results of X-tile software. The structural breakpoints according to the associations between the number of ELNs and the estimated risk of false-negative lymph node dissection and HRs for overall survival were 9 and 8, respectively. The multivariate analysis indicated that ELN number was an independent prognostic factor for OS, both as a continuous or categorical variable. To further explore the effect of more ELNs on survival, another cutoff value of 17 was chosen to compare the survival curves of patients. The multivariate-adjusted COX model showed that patients with ELN<8 had a significantly higher risk of death than those with ELN8-17 (HR=1.447, 95% CI =1.075-1.947, p=0.015), but there was no significant difference in overall survival between patients with ELN>17 and patients with ELN8-17 (HR=0.822, 95%CI =0.665-1.016, p=0.070).

A sufficient number of ELNs was associated with better long-term survival in FIGO stage IB-IIA CSCC. At least 8 ELNs need to be examined for prognostic stratification. Excessive lymph node dissection (ELN>17) may not confer additional survival benefits.

Endometrial cancer is the most common gynecological tract malignancy in developed countries. Extrauterine disease, in particular lymph node metastasis, is an important prognostic factor. Nevertheless, pelvic lymphadenectomy is not considered to have a therapeutic benefit, as it did not improve survival in randomized studies. However, lymphadenectomy may have a therapeutic benefit if adjuvant therapy can be omitted without decreasing oncological outcomes, as the long-term quality of life is maintained by avoiding morbidities associated with adjuvant therapy. In intermediate- and high-risk endometrioid endometrial carcinomas, adjuvant therapy may be safely omitted without decreasing long-term survival by open surgery including systematic pelvic and para-aortic lymphadenectomy when patients are node-negative. Systematic lymphadenectomy may remove undetectable low-volume lymph node metastasis in both pelvic and para-aortic regions, and open surgery may reduce vaginal recurrence even without vaginal brachytherapy. However, lymphadenectomy may not improve survival in elderly patients and patients with p53-mutant tumors.

Endometrial cancer is the most common gynecological tract malignancy in developed countries, and its incidence has been increasing globally with rising obesity rates and longer life expectancy. In endometrial cancer, extrauterine disease, in particular lymph node metastasis, is an important prognostic factor. Nevertheless, pelvic lymphadenectomy is not considered to have a therapeutic benefit, as it did not improve survival in randomized studies. However, lymphadenectomy may have a therapeutic benefit if adjuvant therapy can be omitted without decreasing oncological outcomes, as the long-term quality of life is maintained by avoiding morbidities associated with adjuvant therapy. In intermediate- and high-risk endometrioid endometrial carcinomas, adjuvant therapy may be safely omitted without decreasing long-term survival by open surgery including systematic pelvic and para-aortic lymphadenectomy when patients are node-negative. Systematic lymphadenectomy may remove undetectable low-volume lymph node metastasis in both pelvic and para-aortic regions, and open surgery may reduce vaginal recurrence even without vaginal brachytherapy. However, lymphadenectomy may not improve survival in elderly patients and patients with p53-mutant tumors. In this review, I discuss the characteristics of lymph node metastasis, the methods of lymph node assessment, and the therapeutic benefits of systematic lymphadenectomy in patients with intermediate- and high-risk endometrioid endometrial carcinoma.

• adjuvant therapy
• endometrioid endometrial carcinoma
• high-risk
• intermediate-risk
• node-negative
• pelvic and para-aortic lymphadenectomy
• systematic lymphadenectomy

• Adenocarcinoma/pathology
• Female
• Humans
• Lymph Nodes/pathology
• Lymphatic Metastasis/pathology
• Nomograms
• Uterine Cervical Neoplasms/diagnosis
• Uterine Cervical Neoplasms/pathology

• lymph node metastasis
• lymph node ratio
• radical surgery
• survival
• uterine cervical cancer

• Histological Type of Neoplasm
• Lymph Node Metastasis
• Neoplasm Staging
• Survival
• Uterine Cervical Neoplasms

• Carcinoma, Squamous Cell/pathology
• Female
• Humans
• Lymph Nodes/pathology
• Neoplasm Staging
• Prognosis
• Retrospective Studies
• Uterine Cervical Neoplasms/pathology

• FIGO stage
• cervical cancer
• concurrent chemoradiotherapy
• lymph node
• prognosis
• surgery

This study evaluated the prognostic value of various lymph node (LN) characteristics, including the lymph node ratio (LNR), in patients with cervical cancer treated with radical hysterectomy.

In this retrospective study, 260 patients with cervical cancer who had undergone radical hysterectomy with pelvic or paraaortic lymphadenectomies were included. LN characteristics related to several LN statuses included total LN counts, LN metastasis, total positive LN counts, LNR, and levels of lymphadenectomy. LNR was defined as the number of metastatic LNs divided by the total number of LNs harvested. Univariate and multivariate analyses for disease-free survival (DFS) and overall survival (OS) were performed using the clinicopathological and LN characteristics.

Based on receiver-operating characteristics curve analysis, the cut-off value of LNR was 0.0625. Multivariate analysis revealed that high LNR was significantly related to tumor recurrence (hazard ratio [HR], 5.182; 95% confidence interval [CI], 2.424–11.075; p < 0.0001). After adjusting for clinicopathological factors, LNR was also independent prognostic factor for predicting tumor recurrence (HR, 5.930; 95% CI, 2.114–16.634; p = 0.0007). However, total retrieved LN counts and level of lymphadenectomy were not associated with survival outcomes.

LNR may be a prognostic biomarker for predicting disease recurrence in cervical cancer treated with radical hysterectomy.

• cervical cancer
• lymph node ratio
• prognosis
• radical hysterectomy

• Cervical cancer
• endometrial cancer
• fertility-sparing surgery
• laparoscopic surgery
• pelvic exenteration
• robotic surgery

To determine whether the number of removed lymph nodes (RLN) is associated with survival in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIA cervical squamous cell carcinoma (CSCC).

We reviewed the medical records of FIGO stage IB-IIA CSCC patients who underwent standardized radical hysterectomy with pelvic lymphadenectomy (RHPL) in our center between 2006 and 2014. The X-tile software was performed to calculate the optimal grouping of cutoff points for RLN. The impact of RLN on progression-free survival (PFS) and overall survival (OS) was analyzed using Cox regression analysis.

Among 3,127 patients, the mean number of RLN was 22, and positive lymph node (LN) was found in 668 (21.4%) patients. X-tile plots identified “21” and “16” as the optimal cutoff value of RLN to divide the patients into two groups in terms of PFS and OS separately. In all patients, the number of RLN was not associated with PFS (P=0.182) or OS (P=0.193). Moreover, in both LN positive and negative patients, the number of RLN was not associated with either PFS (P=0.212 and P=0.540, respectively) or OS (P=0.173 and P=0.497, respectively). Cox regression analysis showed that the number of RLN was not an independent prognostic factor for PFS or OS.

If standardized RHPL was performed, the number of RLN was not an independent prognostic factor for survival of patients with FIGO stage IB-IIA CSCC.

To investigate clinical features that affect the number of pelvic lymph nodes (PLNs) harvested and prognostic significance of the number of PLNs removed in patients with stage IB1 to IIA2 cervical cancer.

Data from patients with cervical cancer whom underwent hysterectomy with PLN dissection between June 2004 and July 2015 were reviewed retrospectively. Data on clinicopathologic factors including age, height, and weight were collected. Data on the presence of PLN metastasis on imaging studies prior to surgery, number of PLNs harvested, and presence of metastasis in the harvested PLNs were retrieved from medical records. Clinical features associated with the number of PLNs harvested were analyzed. Disease-free survival (DFS) and overall survival (OS) according to the number of PLNs harvested were analyzed.

During the study period, 210 patients were included. The height and weight of patients and preoperative positive positron emission tomography findings were significantly associated with a higher number of PLNs harvested. As a pathologic factor, larger tumor size was associated with a higher number of PLNs harvested. Furthermore, a higher number of PLNs harvested was associated with a higher number of metastatic PLNs and patients undergoing postoperative concurrent chemoradiation therapy. Patient height and tumor size were independent factors affecting the number of PLNs harvested in multivariate analysis. However, the number of PLNs harvested was not associated with DFS or OS.

The number of PLNs harvested during surgery was associated with patient height; however, this was not related to the prognosis of the disease.

• Lymph node excision
• Lymph nodes
• Uterine cervical neoplasms

The aim of the present study was to introduce a new technique for laparoscopic para-aortic lymphadenectomy (PAL): an invented retroperitoneum suspension needle combined with modified trocar placement.

This prospective pilot study randomly categorized women with cervical cancer of stage I–II into 2 groups. The patients in the study group would have laparoscopic PAL with our new technique, while those in the control group with control method. Patients' characteristics and perioperative outcomes were compared between the 2 groups.

A total of 37 patients were included in our study, of which 20 cases in the study group and 17 cases in the control group. As a result, the mean number of para-aortic lymph nodes (PALNs) resected in the study group was significantly more than that in the control group (p<0.001). The time for resecting PALNs (p<0.001) and total operative time (p<0.001) in the study group decreased significantly than those in the control group.

For laparoscopic PAL, this new technique was effective and practical.

• Cervical Cancer
• Laparoscopy
• Lymphadenectomy
• Para-aortic Lymph Node

• Akaike information criterion
• C index
• CSCC
• LN staging systems
• node-positive
• prognostic value

• Cervical cancer
• Lymph node metastasis
• Lymph node ratio
• Surgical therapy

Lymph nodes draining the primary tumor are essential for the initiation of an effective anti-tumor T-cell immune response. However, cancer-derived immune suppressive factors render the tumor-draining lymph nodes (TDLN) immune compromised, enabling tumors to invade and metastasize. Unraveling the different mechanisms underlying this immune escape will inform therapeutic intervention strategies to halt tumor spread in early clinical stages. Here, we review our findings from translational studies in melanoma, breast, and cervical cancer and discuss clinical opportunities for local immune modulation of TDLN in each of these indications.

• Breast cancer
• Cervical cancer
• Local immunotherapy
• Melanoma
• TIMO 2018
• Tumor-draining lymph node

• cervical cancer
• lymph node metastasis
• micrometastasis
• sentinel lymph node

• lymph node
• prognosis
• uterine cervical neoplasm

• Carcinoma, Squamous Cell/mortality
• Carcinoma, Squamous Cell/pathology
• Carcinoma, Squamous Cell/therapy
• Chemoradiotherapy, Adjuvant
• Female
• Follow-Up Studies
• Humans
• Hysterectomy
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Middle Aged
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Prognosis
• Retrospective Studies
• Survival Rate
• Uterine Cervical Neoplasms/mortality
• Uterine Cervical Neoplasms/pathology
• Uterine Cervical Neoplasms/therapy

• Adult
• Aged
• Cohort Studies
• Female
• Humans
• Hysterectomy/methods
• Lymph Node Excision/methods
• Middle Aged
• Neoplasm Staging
• Radiotherapy, Adjuvant
• Retrospective Studies
• Treatment Outcome
• Uterine Cervical Neoplasms/mortality
• Uterine Cervical Neoplasms/pathology
• Uterine Cervical Neoplasms/radiotherapy
• Uterine Cervical Neoplasms/surgery
• Young Adult

• Cervical cancer
• Hysterectomy
• Lymph node dissection
• Lymph node metastasis
• Prognosis
• Risk factors

• Adult
• Aged
• Cervix Uteri/pathology
• Cervix Uteri/surgery
• Disease-Free Survival
• Female
• Humans
• Hysterectomy/methods
• Lymph Node Excision/methods
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Lymphatic Metastasis/diagnosis
• Lymphatic Metastasis/pathology
• Middle Aged
• Neoplasm Invasiveness/pathology
• Neoplasm Staging
• Pelvis
• Peritoneum/pathology
• Peritoneum/surgery
• Prognosis
• Retrospective Studies
• Risk Factors
• Uterine Cervical Neoplasms/mortality
• Uterine Cervical Neoplasms/pathology
• Uterine Cervical Neoplasms/surgery
• Young Adult

• SEER
• cervical cancer
• negative lymph node
• radical surgery

The prognostic impact of the number of examined lymph nodes (ELNs) in different histological subtypes of cervical cancer remains unclear. We aimed to assess the impact of the number of ELNs in stage IA2–IIA cervical cancer with different histological subtypes.

Data of patients with stage IA2–IIA squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the uterine cervix between 1988 and 2013 were retrieved from the Surveillance, Epidemiology, and End Results program. Univariate and multivariate Cox regression analyses were performed to analyze the effect of number of ELNs on cause-specific survival (CSS) and overall survival (OS).

The final data set identified 11,830 patients including 7,920 (66.9%) women with SCC and 3,910 (33.1%) with AC. The median number of ELNs was 19. The multivariate analysis indicated that the number of ELNs was an independent prognostic factor influencing CSS and OS, both as a continuous or a categorical variable. Patients with a higher number of ELNs had better survival outcomes. In SCC subtype, the number of ELNs was also the independent prognostic factor of CSS and OS in node-positive patients, but not in patients with node-negative disease. In AC patients, ELN count was not an independent predictor of CSS and OS regardless of lymph node status.

The number of ELNs is an independent prognostic factor in patients with stage IA2–IIB cervical cancer. A higher number of ELNs is associated with better survival outcomes, especially in the node-positive SCC subtype.

• SEER
• cervical cancer
• early stage
• histological subtype
• nodal positive
• prognosis

• lymph node excision
• lymph nodes
• prognosis
• uterine cervical neoplasms

• cervical cancer
• lymphadenectomy
• negative
• number of lymph nodes
• survival

Sentinel lymph node (SLN) biopsies are a sensitive tool in evaluating lymph nodes for multiple cancers, and in some diseases they decrease morbidity in both the short- and long-term. SLN detection in gynecologic malignancies has been studied extensively over the past decade. We review the current literature on SLN dissection in vulvar, endometrial and cervical cancers. Large, well-designed trials in each of the three types of cancer have demonstrated high sensitivity and low false-negative rates when SLN biopsy is performed in the correct patients and with an appropriate technical approach. In all of these cases the addition of ultra-staging to conventional pathology yields increased detection of micrometastatic disease. Biopsy of the sentinel nodes is feasible and safe in early vulvar malignancies, with multiple studies describing low recurrence rates in those women who have with negative SLNs. There does not appear to be a survival benefit to lymphadenectomy over SLN biopsy and quality of life is improved in women undergoing SLN biopsy. Optimal treatment strategies for women with positive nodal biopsies, particularly in cases with micrometastatic disease, remain unclear. Multiple large studies investigating the utility of SLN biopsy in endometrial malignancy have found that sentinel nodal status is a reliable predictor of metastases in women with low-risk disease. Prospective studies are ongoing and suggest sentinel nodal detection may soon become widely accepted as an alternative standard of care for select cases of endometrial cancer. In cervical cancer, SLN biopsy is accurate for diagnosing metastatic disease in early stage tumors (≤ 2 cm diameter or stage ≤ IB2) where the risk of metastasis is low. It is unknown if women who undergo SLN biopsy alone will have different survival outcomes than women who undergo complete lymphadenectomy in these cases. In a specific population of women with vulvar cancer, SLN dissection is an effective and safe alternative to complete dissection. It can be offered as an alternative management strategy in these women. In women who do undergo SLN biopsy, it is associated with improved quality of life. Promising evidence supporting the utility of SLN dissection in endometrial and cervical cancer continues to emerge, and it may soon become a reasonable option for select patients. However, continued research and refinement of appropriate patient selection and long-term follow-up are necessary.

• Gynecologic malignancies
• Sentinel lymph node
• Endometrial cancer
• Cervical cancer
• Vulvar cancer

• Extraperitoneal
• Gynaecological cancer
• Lymphadenectomy
• Retroperitoneal
• Robotics
• Transperitoneal

• cervical cancer
• debulking
• endometrial cancer
• germ cell cancer
• gynaecological cancer
• lymph node

Purpose: The purpose of this study was to assess the risk factors for pelvic lymph node metastasis (PLNM) in patients with early-stage uterine cervical cancer.

Methods: A total of 192 patients with early-stage uterine cervical cancer (FIGO stage IA2, IB1, and IIA1) receiving radical hysterectomy with pelvic lymphadenectomy were included in the statistical analysis.

Results: Thirty-six patients (18.8%) developed PLNM, and the incidences of PLNM in patients with stage IA2, stage IB2, and stage IIA1 were 0% (0/6), 13.9% (20/144), and 38.1% (16/42), respectively. The most common location of PLNM was the obturator lymph node. Univariate analysis showed that stage IIA1 (p < 0.001), tumor size greater than 3 cm (p = 0.019), deep-full thickness stromal invasion (p < 0.001), and lymphovascular invasion (p = 0.001) were associated with PLNM. Multivariate analysis showed that deep or full-thickness stromal invasion and lymphovascular invasion were significantly and independently associated with PLNM (p < 0.05 for both). The incidence of PLNM was 34.9% and 28.7% in patients with deep-full thickness stromal invasion and lymphovascular invasion, respectively, but that was only 5.7% and 9.2% in patients with superficial-middle stromal invasion and absence of lymphovascular invasion, respectively.

Conclusion: Patients with superficial-middle stromal invasion and without lymphovascular invasion may be avoided pelvic lymphadenectomy in stage IA2, IB1, IIA1 uterine cervical cancer.

• Uterine cervical cancer
• lymph node metastasis
• lymphovascular invasion
• pelvic lymphadenectomy
• stromal invasion

The aim of this study was to estimate the survival impact of lymphadenectomy in patients diagnosed with uterine clear cell cancer (UCCC).

Patients with a diagnosis of UCCC were identified from Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2007. Only surgically treated patients were included. Statistical analysis using Student t-test, Kaplan-Meier survival methods, and Cox proportional hazard regression were performed.

One thousand three hundred eighty-five patients met the inclusion criteria; 955 patients (68.9%) underwent lymphadenectomy. Older patients (≥65) were less likely to undergo lymphadenectomy compared with their younger cohorts (64.3% vs. 75.9%, p<0.001). The prevalence of nodal metastasis was 24.8%. Out of 724 women who had disease clinically confined to the uterus and underwent lymphadenectomy, 123 (17%) were found to have nodal metastasis. Lymphadenectomy was associated with improved survival. Patients who underwent lymphadenectomy were 39% (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.52 to 0.72; p<0.001) less likely to die than patient who did not have the procedure. Moreover, more extensive lymphadenectomy correlated positively with survival. Compared to patients with 0 nodes removed, patients with more extensive lymphadenectomy (1 to 10 and >10 nodes removed) were 32% (HR, 0.68; 95% CI, 0.56 to 0.83; p<0.001) and 47% (HR, 0.53; 95% CI, 0.43 to 0.65; p<0.001) less likely to die, respectively.

The extent of lymphadenectomy is associated with an improved survival of patients diagnosed with UCCC.

• Endometrial Neoplasms
• Lymph Node Excision
• Retrospective Studies
• Survival Rate

• anatomical variations
• internal iliac vein
• presacral area

The objective of this study is to construct a preoperative nomogram predicting lymph node metastasis (LNM) in early-cervical cancer patients.

Between 2009 and 2012, 493 early-cervical cancer patients received hysterectomy and pelvic/para-aortic lymphadenectomy. Patients who were diagnosed during 2009–2010 were assigned to a model-development cohort (n=304) and the others were assigned to a validation cohort (n=189). A multivariate logistic model was created from preoperative clinicopathologic data, from which a nomogram was developed and validated. A predicted probability of LNM<5% was defined as low risk.

Age, tumour size assessed by magnetic resonance imaging, and LNM assessed by positron emission tomography/computed tomography were independent predictors of nodal metastasis. The nomogram incorporating these three predictors demonstrated good discrimination and calibration (concordance index=0.878; 95% confidence interval (CI), 0.833−0.917). In the validation cohort, the discrimination accuracy was 0.825 (95% CI, 0.736−0.895). In the model-development cohort, 34% of them were classified as low risk and negative predictive value (NPV) was 99.0%. In the validation cohort, 38% were identified as low risk and NPV was 95.8%. Integrating the model-development and validation cohorts, negative likelihood ratio was 0.094 (95% CI, 0.036−0.248).

A robust nomogram predicting LNM in early cervical cancer was developed. This model may improve clinical trial design and help physicians to decide whether lymphadenectomy should be performed.

• Cervical cancer
• Clinical feature
• Surgery
• Survival rate
• Therapeutic strategies

• Adult
• Chemotherapy, Adjuvant
• China
• Female
• Humans
• Middle Aged
• Neoplasm Staging
• Prevalence
• Uterine Cervical Neoplasms/drug therapy
• Uterine Cervical Neoplasms/epidemiology
• Uterine Cervical Neoplasms/pathology
• Uterine Cervical Neoplasms/surgery

• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Autonomic Pathways/pathology
• Autonomic Pathways/surgery
• Carcinoma, Adenosquamous/pathology
• Carcinoma, Adenosquamous/surgery
• Carcinoma, Squamous Cell/pathology
• Carcinoma, Squamous Cell/surgery
• Female
• Follow-Up Studies
• Humans
• Hysterectomy
• Lymph Node Excision
• Lymphatic Metastasis
• Middle Aged
• Neoplasm Staging
• Pelvis/pathology
• Pelvis/surgery
• Prognosis
• Prospective Studies
• Robotics
• Uterine Cervical Neoplasms/pathology
• Uterine Cervical Neoplasms/surgery