Publication details

Stratification of lymph node metastases as macrometastases, micrometastases, or isolated tumor cells has no clinical implication in patients with cervical cancer: Subgroup analysis of the SCCAN project

Authors

DOSTALEK Lukas BENEŠOVÁ Klára KLAT Jaroslav KIM Sarah H FALCONER Henrik KOSTUN Jan RICARDO dos Reis ZAPARDIEL Ignacio LANDONI Fabio ORTIZJ David Isla VAN LONKHUIJZEN Luc R C W LOPEZ Aldo ODETTO Diego BORCINOVA Martina JARKOVSKÝ Jiří SALEHI Sahar NEMEJCOVA Kristyna BAJSOVA Sylva PARK Kay J JAVURKOVA Veronika ABU-RUSTUM Nadeem R DUNDR Pavel CIBULA David

Year of publication 2023
Type Article in Periodical
Magazine / Source Gynecologic Oncology
MU Faculty or unit

Faculty of Medicine

Citation
Web https://www.sciencedirect.com/science/article/pii/S0009898122014279
Doi http://dx.doi.org/10.1016/j.ygyno.2022.11.017
Keywords Micrometastasis; Cervical cancer; Low volume metastasis; Disease-free survival; Histopathological ultrastaging; Isolated tumor cells; Sentinel lymph node; Macrometastasis; Classification; Prognosis
Description Background. In cervical cancer, presence of lymph-node macrometastases (MAC) is a major prognostic factor and an indication for adjuvant treatment. However, since clinical impact of micrometastases (MIC) and isolated tumor-cells (ITC) remains controversial, we sought to identify a cut-off value for the metastasis size not associ-ated with negative prognosis.Methods. We analyzed data from 967 cervical cancer patients (T1a1L1-T2b) registered in the SCCAN (Surveil-lance in Cervical CANcer) database, who underwent primary surgical treatment, including sentinel lymph-node (SLN) biopsy with pathological ultrastaging. The size of SLN metastasis was considered a continuous variable and multiple testing was performed for cut-off values of 0.01-1.0 mm. Disease-free survival (DFS) was compared be-tween N0 and subgroups of N1 patients defined by cut-off ranges.Results. LN metastases were found in 172 (18%) patients, classified as MAC, MIC, and ITC in 79, 54, and 39 pa-tients, respectively. DFS was shorter in patients with MAC (HR 2.20, P = 0.003) and MIC (HR 2.87, P < 0.001), while not differing between MAC/MIC (P = 0.484). DFS in the ITC subgroup was neither different from N0 (P = 0.127) nor from MIC/MAC subgroups (P = 0.449). Cut-off analysis revealed significantly shorter DFS com-pared to N0 in all subgroups with metastases >= 0.4 mm (HR 2.311, P = 0.04). The significance of metastases <0.4 mm could not be assessed due to limited statistical power (<80%). We did not identify any cut-off for the size of metastasis with significantly better prognosis than the rest of N1 group.Conclusions. In cervical cancer patients, the presence of LN metastases >= 0.4 mm was associated with a signif-icant negative impact on DFS and no cut-off value for the size of metastasis with better prognosis than N1 was found. Traditional metastasis stratification based on size has no clinical implication.

You are running an old browser version. We recommend updating your browser to its latest version.

More info