Introduction Pelvic lymph-nodal involvement is a major prognostic factor in cervical cancer. Lymph-node status is classically assessed by lymph-node dissection. This surgical approach is mainly of prognostic interest. In this study, we aimed to identify the risk factors associated with pelvic lymph node metastases (PLNM) in locally advanced cervical cancer.

Methods We conducted a retrospective study at the Salah Azaiez Institute of Oncology from January 1, 2010, to December 31, 2020, including 118 patients with locally advanced cervical cancer who underwent radical hysterectomy, pelvic exenteration, and systematic pelvic lymphadenectomy. All removed pelvic nodes were pathologically examined. Risk factors for PLNM were evaluated.

Results Among 118 operated patients, 115 underwent surgery after radiochemotherapy (97.5%) while 3 patients (2.5%) underwent exclusive surgery. Pelvic lymph node metastases were found in 12 cases (10.4%). In our study, lymphovascular space involvement p (0.00) and suspicious pelvic lymph nodes on MRI p (0.045) were identified as risk factors of PLNM. In contrast, tumor size p (0.897), parametrial involvement p (0.073), and histologic grade p (0.835) were not related to the risk of lymph node invasion.

Conclusion/Implications Lymphovascular space involvement and suspicious pelvic lymph nodes on MRI were independent prognostic factors for pelvic lymph node involvement in locally advanced cervical cancer patients.