Full - thickness infiltration in cervical squamous cell carcinoma: pathological factors and clinical prognoses

Abstract Objective To systematically explore the effects of clinicopathological characteristics on lymph node metastasis (LNM) and long-term overall survival (OS) in cervical squamous cell carcinoma patients, and to further identify risk factors for high-level and multiple lymph node metastases. Methods A total of 788 patients who underwent surgical treatment for cervical squamous cell carcinoma between June 2012 and March 2019 were retrospectively included. Stratified Cox proportional hazards regression models stratified by pathological grade were constructed to screen independent prognostic factors for OS and address minor proportional hazards assumption violation. Restricted cubic spline (RCS) binary logistic regression and conventional multivariable logistic regression were performed to evaluate independent predictors of overall lymph node metastasis, high-level (common iliac artery and above) lymph node metastasis, and three or more metastatic lymph nodes (gLNM3). Results Increased tumor volume (HR = 1.006, P = 0.007), positive lymphovascular space invasion (LVSI, HR = 1.961, P < 0.001), positive vaginal invasion (HR = 1.753, P = 0.001), and positive lymph node metastasis (HR = 2.938, P < 0.001) were confirmed as independent adverse prognostic factors for OS. No postoperative adjuvant treatment modality significantly affected patient survival. RCS logistic regression revealed a marginally significant overall association between continuous tumor volume and lymph node metastasis (global P = 0.053), with a positive linear risk trend observed within the tumor volume range of 10–35 cm³ (OR = 1.866, P = 0.040). Multivariable logistic regression identified LVSI positivity (OR = 4.276, P < 0.001), pathological grade III (OR = 1.706, P = 0.002), endogenic tumor growth pattern (OR = 2.676, P = 0.008), and mass-type gross tumor (OR = 6.455, P = 0.016) as independent risk factors for lymph node metastasis. Among patients with pelvic lymph node metastasis, tumor maximum diameter > 4 cm (OR = 2.290, P = 0.027) and positive LVSI (OR = 3.889, P < 0.001) were independent predictors of high-level lymph node metastasis. Furthermore, LVSI positivity independently increased the risk of having ≥ 3 metastatic lymph nodes (OR = 2.195, P = 0.005). Conclusion Tumor volume, LVSI, vaginal invasion, and lymph node metastasis are robust independent prognostic indicators for overall survival in cervical squamous cell carcinoma patients. LVSI serves as a core risk factor that comprehensively promotes overall, high-level, and multiple lymph node metastases. Tumor volume exhibits a marginal linear predictive effect on lymph node metastasis, while adjuvant treatment shows no significant impact on patient long-term survival.