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

• Autoři: 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
• Rok publikování: 2023
• Druh: Článek v odborném periodiku
• Časopis / Zdroj: Gynecologic Oncology
• Fakulta / Pracoviště MU: Lékařská fakulta
• www: https://www.sciencedirect.com/science/article/pii/S0009898122014279
• Doi: http://dx.doi.org/10.1016/j.ygyno.2022.11.017
• Klíčová slova: Micrometastasis; Cervical cancer; Low volume metastasis; Disease-free survival; Histopathological ultrastaging; Isolated tumor cells; Sentinel lymph node; Macrometastasis; Classification; Prognosis
• Popis: 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.