Abstract
Background: With the development of the sentinel node technique in early-stage cervical cancer, it is imperative to define the clinical significance of micrometastases (MICs) and isolated tumor cells (ITCs). Methods: We included all patients who participated in the Senticol 1 and Senticol 2 studies. We analyzed the factors associated with the presence of low-volume metastasis, the oncological outcomes of patients with MIC and ITC and the correlation of recurrences and risk factors. Results: Twenty-four patients (7.5%) had low-volume metastasis. The risk factors associated with the presence of low-volume metastasis were a higher stage (p = 0.02) and major stromal invasion (p = 0.01) in the univariate analysis. The maximum specificity and sensitivity were found at a cutoff of 8 mm of stromal invasion. In multivariate analysis, the higher stage (p = 0.02) and the positive lymphovascular space invasion (p = 0.02) were significantly associated with the MIC and ITC. Patients with low-volume metastasis had similar disease-free survival (DFS) (92.7%) to node-negative patients (93.6%). The addition of adjuvant treatment in presence of low-volume metastasis did not modify the DFS. Conclusions: These results confirm our previous analysis of Senticol 1: the presence of low-volume metastasis did not decrease the DFS in early-stage cervical cancer patients.
Highlights
In early-stage cervical cancer, the status of the lymph nodes is one of the most important prognostic factors
321 patients fulfilled the inclusion criteria and were included in this study, ultrastaging analysis was performed for all non-sentinel lymph nodes (NSLN) in 141 patients (44% of patients)
For the remaining patients, ultrastaging was only performed for SLN
Summary
In early-stage cervical cancer, the status of the lymph nodes is one of the most important prognostic factors. Defined lymph node involvement as a stage IIIC disease and highlighted the importance of lymph node metastasis as a major prognostic factor in cervical cancer. The systematic ultrastaging of sentinel lymph nodes (SLNs) has frequently led to diagnoses of isolated tumor cells (ITCs) or micrometastases (MICs). With the development of the sentinel node technique in early-stage cervical cancer, it is imperative to define the clinical significance of micrometastases (MICs) and isolated tumor cells (ITCs). We analyzed the factors associated with the presence of low-volume metastasis, the oncological outcomes of patients with MIC and ITC and the correlation of recurrences and risk factors
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