Assessment of pelvic lymph node micrometastatic disease in stages IB and IIA of carcinoma of the uterine cervix

Abstract

The objective of this study was to assess the frequency of micrometastatic disease (MID) in pelvic lymph nodes (PLNs) in carcinoma of the uterine cervix (CUC) and to determine the risk of recurrence. The PLNs from 289 patients with CUC (IB and IIA) were studied. Each PLN was assessed via immunohistochemistry using a single histologic section (AE1/AE3). Metastatic deposits were measured and the disease status was classified into three groups: 1) absence of metastatic disease (MOD); 2) MID, one or more metastatic PLN with only isolated tumor cells and/or micrometastases (up to 2 mm); and 3) macrometastatic disease (MAD), presence of one or more metastatic PLN with macrometastases (more than 2 mm). Eleven patients (3.8%) were classified as having MID and 37 (12.8%) as having MAD. The 5-year disease-free survival (DFS) rates for MOD, MAD, and MID were 88.7%, 80.4%, and 50.0%, respectively (P < 0.001). The Cox proportional hazards model showed that MID was an independent variable for recurrence when adjusted for MAD, depth of tumor invasion, severity of inflammatory reaction, and use of adjuvant radiotherapy. We conclude that the frequency of MID in PLN was low. However, patients with MID presented a high risk of recurrence and reduced DFS.

Rate of Para-Aortic Lymph Node Micrometastasis in Patients with Locally Advanced Cervical Cancer

“…Our study is unique in that we focused on determining the rate of micrometastases in the para-aortic nodes of patients with locally advanced disease. Interestingly, most of this retrospective data in cervical cancer show a trend with micrometastasis patients having worse prognosis and higher rates of recurrence than patients without nodal metastases [11][12][13]. The reported rates of micrometastatic disease in early-stage cervical cancer range from 3.8% to 50% [11,14].…”

“…Interestingly, most of this retrospective data in cervical cancer show a trend with micrometastasis patients having worse prognosis and higher rates of recurrence than patients without nodal metastases [11][12][13]. The reported rates of micrometastatic disease in early-stage cervical cancer range from 3.8% to 50% [11,14]. This broad range in incidence is likely a result of the lack of clear definition of micrometastasis in gynecologic cancers and the use of different methods to detect micrometastasis.…”

“…In cervical cancer, there are no data from prospective long-term trials on the prognostic value of micrometastasis; the majority of studies examining micrometastasis in cervical cancer have been retrospective analyses in patients with early-stage disease and such studies have only evaluated micrometastases in pelvic lymph nodes [11,12]. Our study is unique in that we focused on determining the rate of micrometastases in the para-aortic nodes of patients with locally advanced disease.…”

“…Furthermore, the clinical significance of PCR-detected micrometastasis requires further prospective validation. Currently, the majority of studies of the detection of micrometastasis in patients with cervical cancer have used serial sectioning and/or IHC [11,13,15,16].…”

“…Fregnani et al [11] performed a retrospective analysis of 289 patients with stage IB to IIA cervical cancer and found the rate of micrometastasis to be 3.8%. Compared with nodenegative patients, patients with micrometastasis had a higher rate of recurrence (3.2 times as high as that of node-negative patients) and reduced disease free survival.…”