Incorporation of sentinel lymph node biopsy in cervical cancer surgery: Recent U.S. population trends (342)

Abstract

<b>Objectives:</b> The utility of sentinel lymph node (SLN) biopsy in the surgical treatment of women with early cervical cancer is currently under active investigation. This study examined the trends, characteristics, and outcomes of SLN biopsy for cervical cancer surgery. <b>Methods:</b> This retrospective observational study queried the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. The study population included women with invasive cervical cancer (squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma) who underwent both hysterectomy and lymphadenectomy for non-metastatic T1 disease from 2003-2018. The exposure allocation was per lymph node evaluation type (SLN biopsy or lymphadenectomy). The main outcome measures were <i>(i)</i> trend of utilization and patient characteristics related to SLN biopsy assessed with multivariable analysis and <i>(ii)</i> overall survival associated with SLN biopsy assessed with propensity score inverse probability of treatment weighting. Sensitivity cohorts included uterine-preserving conservative surgeries. <b>Results:</b> A total of 12,966 women met the inclusion criteria. Of those, 430 (3.3%) women underwent SLN biopsy. The utilization of SLN biopsy increased significantly from 0.8% to 15.2% during the study period (p<0.001). This association remained independent in multivariable analysis: 2011-2014 versus 2003-2010 with an adjusted odds ratio of 4.87, 95% CI: 3.29-7.23, and 2015-2018 versus 2003-2010 with an adjusted odds ratio of 20.6, 95% CI: 14.6-29.2. In a propensity score weighted model, women who had SLN biopsy had similar overall survival compared to those without SLN biopsy (3-year rates, 94.8% vs 94.2%, HR: 0.95, 95% CI: 0.64-1.41, p=0.799). The increase in SLN biopsy was also observed in uterine-preserving surgeries (3.5% to 9.6% for trachelectomy, p=0.043; and 2.5% to 19.5% in cervical excision, p<0.001). <b>Conclusions:</b> The landscape of surgical nodal evaluation is shifting from lymphadenectomy to SLN biopsy in cervical cancer surgery. Survival effects of SLN biopsy-incorporated surgical treatment in early cervical cancer merit further evaluation. Fig. 1