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Abstract Objective To investigate the influence of postoperative pathological factors (including variables not categorized as moderate - to - high - risk factors according to the Sedlis criteria) on the prognosis and lymph node metastasis of patients with cervical squamous cell carcinoma. Methods A retrospective analysis was carried out on 1393 inpatients admitted to our hospital from June 2012 to March 2019. The 60 - month overall survival rate was analyzed in accordance with the postoperative pathological outcomes. Subsequently, individual survival analysis was performed on patients with lymph node metastasis to elucidate the influence of different lymph node metastasis conditions on patient prognosis. Finally, multiple - factor binary logistic regression was employed to identify the relevant factors that facilitate lymph node metastasis. Results The univariate Cox regression survival model indicates that lymph node metastasis, tumor volume (≥ 14.50 cm³), vaginal invasion, vascular invasion, pathological grade Ⅲ, nerve invasion, endogenous growth pattern, and infiltration into the outer one - third of the cervical wall are significant factors influencing the 5 - year survival rate of patients (p < 0.05). The multivariate Cox regression survival model reveals that lymph node metastasis, vaginal invasion, vascular invasion and pathological grade Ⅲ are independent prognostic factors affecting the 5 - year survival of patients (p < 0.05), with the risks of 5 - year mortality increasing by 172%, 56%, 49%, and 47% respectively. A comparison of survival analysis between lymph node metastasis to the common iliac artery and above and lymph node metastasis in the pelvic cavity demonstrated that the 5 - year overall survival rates of the two groups were 50% and 74.8% respectively, p < 0.001. Vascular invasion, infiltration into the outer one - third of the cervical wall, location: endogenous (non - exogenous), growth mode: mass (non - ulcer), vaginal invasion, and pathological grade Ⅲ are independent factors affecting lymph node metastasis. The aforementioned indicators elevate the risk of lymph node metastasis by 357%, 266%, 77%, 237%, 44%, and 43% respectively. Vascular invasion and three - dimensional tumor volume are risk factors for lymph node metastasis in patients’ iliac arteries, veins, and higher positions, with the risks increasing by 200% and 92% respectively. Conclusion Lymph node metastasis, vascular invasion, tumor diameter, and volume remain the primary factors influencing patient prognosis. Nevertheless, greater attention should be given to pathological grading, tumor location (endogenous or exogenous), growth pattern (presence or absence of ulcer formation), nerve invasion, and uterine invasion, and their impacts on prognosis require further clarification. In comparison to patients with only pelvic lymph node metastasis, those with lymph node metastasis in the common iliac artery and above exhibit a poorer prognosis. The mechanism of lymph node metastasis may differ significantly from that of lymph node metastasis at higher positions (common iliac artery and above). Tumors with vascular invasion and larger volumes are more likely to develop lymph node metastasis outside the pelvic cavity. For such patients, the original pelvic lymph node irradiation scope may need adjustment, and further research is required to ascertain whether extended irradiation of the abdominal aortic field can enhance patient survival.
