Micrometastases in Sentinel Lymph Nodes Represent a Significant Negative Prognostic Factor in Early-Stage Cervical Cancer: A Single-Institutional Retrospective Cohort Study

Authors

KOCIAN Roman SLAMA Jiri FISCHEROVA Daniela GERMANOVA Anna BURGETOVA Andrea DUŠEK Ladislav DUNDR Pavel NEMEJCOVA Kristyna JARKOVSKÝ Jiří SEBESTOVA Silvie FRUHAUF Filip DOSTALEK Lukas BALLASCHOVA Tereza CIBULA David

Year of publication 2020
Type Article in Periodical
MU Faculty or unit

Faculty of Medicine

Citation
Web https://www.mdpi.com/2072-6694/12/6/1438
Doi http://dx.doi.org/10.3390/cancers12061438
Keywords micrometastasis; isolated tumor cells; sentinel lymph node; cervical cancer; pathological ultrastaging; prognostic parameters; risk of recurrence
Description The data on the prognostic significance of low volume metastases in lymph nodes (LN) are inconsistent. The aim of this study was to retrospectively analyze the outcome of a large group of patients treated with sentinel lymph node (SLN) biopsy at a single referral center. Patients with cervical cancer, stage T1a-T2b, common tumor types, negative LN on preoperative staging, treated by primary surgery between 01/2007 and 12/2016, with at least unilateral SLN detection were included. Patients with abandoned radical surgery due to intraoperative SLN positivity detected by frozen section were excluded. All SLNs were postoperatively processed by an intensive protocol for pathological ultrastaging. Altogether, 226 patients were analyzed. Positive LN were detected in 38 (17%) cases; macrometastases (MAC), micrometastases (MIC), isolated tumor cells (ITC) in 14, 16, and 8 patients. With the median follow-up of 65 months, 22 recurrences occurred. Disease-free survival (DFS) reached 90% in the whole group, 93% in LN-negative cases, 89% in cases with MAC, 69% with MIC, and 87% with ITC. The presence of MIC in SLN was associated with significantly decreased DFS and OS. Patients with MIC and MAC should be managed similarly, and SLN ultrastaging should become an integral part of the management of patients with early-stage cervical cancer.

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