Clinicopathological Determinants of Lymph Node Metastasis in Early-Stage Cervical Cancer: A Retrospective Cohort Study

<b>Aims/Background</b> Accurate identification of lymph node metastasis is critical for optimising surgical strategies in early-stage cervical cancer. This study aimed to analyse multiple clinicopathological factors which are potentially associated with lymph node metastasis to guide personalised lymphadenectomy decisions. <b>Methods</b> This retrospective cohort study included 266 patients with early-stage cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] stage IA1 to IIA2) who underwent surgical treatment at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, between 1 December 2014 and 31 December 2019. Patients were followed up every 3 months for the first 2 years, every 6 months for the next 3 years, and annually thereafter. The presence of lymph node metastasis was included as the primary outcome, while the associated factors as secondary outcomes. The univariate and multivariate logistic regression were performed to identify risk factors associated with lymph node metastasis. <b>Results</b> The mean age of the study participants (n = 266) was 44.26 years (standard deviation [SD] = 10.19), and the median follow-up duration was 48.7 months (range 12-72 months). Lymph node metastasis was observed in 15.41% of patients. The metastatic rates increased with advancing FIGO stage: IA1 and IA2 (0%), IB1 (13.44%), IB2 (15.00%), IIA1 (23.33%), and IIA2 (66.67%). Univariate analysis identified FIGO stage (<i>p</i> < 0.001), depth of stromal invasion (<i>p</i> < 0.001), tumour size (<i>p</i> = 0.017), parametrial invasion (<i>p</i> < 0.001), and lymphovascular space invasion (LVSI) (<i>p</i> < 0.001) as significantly associated risk factors for lymph node metastasis. Multivariate analysis identified tumour size ≥4 cm (adjusted odds ratio [OR]: 3.857; 95% confidence interval [CI]: 1.530-9.728; <i>p</i> = 0.004), FIGO stage II (adjusted OR: 8.247; 95% CI: 3.171-21.455; <i>p</i> < 0.001), LVSI (adjusted OR: 2.974; 95% CI: 1.344-6.632; <i>p</i> = 0.008), and parametrial invasion (adjusted OR: 5.585; 95% CI: 1.900-16.415; <i>p</i> = 0.002) as independent risk factors for nodal metastasis. <b>Conclusion</b> This study identifies several key clinicopathological factors associated with lymph node metastasis in early-stage cervical cancer. These findings underscore the importance of meticulous preoperative risk assessment and offer an evidence-based foundation for tailored surgical planning to improve patient outcomes.