Publication details

Survival associated with the use of sentinel lymph node in addition to lymphadenectomy in early-stage cervical cancer treated with surgery alone: A sub-analysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study

Authors	BIZZARRI Nicolo QUERLEU Denis RAMIREZ Pedro T DOSTALEK Lukas VAN LONKHUIJZEN Luc R C W GIANNARELLI Diana LOPEZ Aldo SALEHI Sahar AYHAN Ali KIM Sarah H ORTIZ David Isla KLAT Jaroslav LANDONI Fabio PAREJA Rene MANCHANDA Ranjit KOSTUN Jan MEYDANLI Mehmet M ODETTO Diego LAKY Rene ZAPARDIEL Ignacio WEINBERGER Vít RICARDO Dos Reis ANCHORA Luigi Pedone AMARO Karina AKILLI Huseyin ABU-RUSTUM Nadeem R SALCEDO-HERNANDEZ Rosa A JAVURKOVA Veronika MOM Constantijne H FALCONER Henrik SCAMBIA Giovanni CIBULA David
Year of publication	2024
Type	Article in Periodical
Magazine / Source	European Journal of Cancer
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.sciencedirect.com/science/article/pii/S0959804924009663?via%3Dihub
Doi	http://dx.doi.org/10.1016/j.ejca.2024.114310
Keywords	Cervical cancer; Sentinel lymph node; Lymphadenectomy; Survival; Recurrence; Ultrastaging
Description	Aim: The aim of this study was to assess whether the use of sentinel lymph node (SLN) in addition to lymphadenectomy was associated with survival benefit in patients with early-stage cervical cancer. Methods: International, multicenter, retrospective study. Inclusion criteria: cervical cancer treated between 01/2007 and 12/2016 by surgery only; squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma, FIGO 2009 stage IB1-IIA2, negative surgical margins, and laparotomy approach. Patients undergoing neo-adjuvant and/or adjuvant treatment and/or with positive para-aortic lymph nodes, were excluded. Women with positive pelvic nodes who refused adjuvant treatment, were included. Lymph node assessment was performed by SLN (with ultrastaging protocol) plus pelvic lymphadenectomy ('SLN' group) or pelvic lymphadenectomy alone ('non-SLN' group). Results: 1083 patients were included: 300 (27.7 %) in SLN and 783 (72.3 %) in non-SLN group. 77 (7.1 %) patients had recurrence (N = 11, 3.7 % SLN versus N = 66, 8.4 % non-SLN, p = 0.005) and 34 (3.1 %) (N = 4, 1.3 % SLN versus N = 30, 3.8 % non-SLN, p = 0.033) died. SLN group had better 5-year disease-free survival (DFS) (96.0 %,95 %CI:93.5-98.5 versus 92.0 %,95 %CI:90.0-94.0; p = 0.024). No 5-year overall survival (OS) difference was shown (98.4 %,95 %CI:96.8-99.9 versus 96.8 %,95 %CI:95.4-98.2; p = 0.160). SLN biopsy and lower stage were independent factors associated with improved DFS (HR:0.505,95 %CI:0.266-0.959, p = 0.037 and HR:2.703,95 %CI:1.389-5.261, p = 0.003, respectively). Incidence of pelvic central recurrences was higher in the non-SLN group (1.7 % versus 4.5 %, p = 0.039). Conclusion: Adding SLN biopsy to pelvic lymphadenectomy was associated with lower recurrence and death rate and improved 5-year DFS. This might be explained by the lower rate of missed nodal metastasis thanks to the use of SLN ultrastaging. SLN biopsy should be recommended in patients with early-stage cervical cancer.