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

Abstract

ObjectiveTo examine the trends, characteristics, and outcomes related to sentinel lymph node (SLN) biopsy for cervical cancer surgery. MethodsThis retrospective cohort study queried the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Study population included patients with invasive cervical cancer (squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma) who underwent both hysterectomy and lymphadenectomy for T1 classification from 2003 to 2018. Exposure allocation was per surgical nodal evaluation type (SLN biopsy or lymphadenectomy). Main outcome measures were (i) trend of utilization and patient characteristics related to SLN biopsy assessed with multivariable analysis and (ii) overall survival associated with SLN biopsy assessed with propensity score inverse probability of treatment weighting. Sensitivity cohorts included uterine-preserving conservative surgeries. ResultsA total of 12,966 patients met the inclusion criteria. Of those, 430 (3.3%) patients 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 adjusted-odds ratio 4.87, 95% confidence interval (CI) 3.29–7.23, and 2015–2018 versus 2003–2010 adjusted-odds ratio 20.6, 95%CI 14.6–29.2. In a propensity score weighted model, patients who had SLN biopsy had similar overall survival compared to those without SLN biopsy (3-year rates, 94.8% versus 94.2%, hazard ratio 0.95, 95%CI 0.64–1.41, P = 0.799). In sensitivity analysis, 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). ConclusionLandscape of surgical nodal evaluation is gradually shifting from lymphadenectomy to SLN biopsy in cervical cancer surgery.