The Clinical Impact of Low-Volume Lymph Nodal Metastases in Early-Stage Cervical Cancer: The Senticol 1 and Senticol 2 Trials

Abstract

Background: With the development of the sentinel node technique in early-stage cervical cancer, it is imperative to define the clinical significance of micrometastases (MICs) and isolated tumor cells (ITCs). Methods: We included all patients who participated in the Senticol 1 and Senticol 2 studies. We analyzed the factors associated with the presence of low-volume metastasis, the oncological outcomes of patients with MIC and ITC and the correlation of recurrences and risk factors. Results: Twenty-four patients (7.5%) had low-volume metastasis. The risk factors associated with the presence of low-volume metastasis were a higher stage (p = 0.02) and major stromal invasion (p = 0.01) in the univariate analysis. The maximum specificity and sensitivity were found at a cutoff of 8 mm of stromal invasion. In multivariate analysis, the higher stage (p = 0.02) and the positive lymphovascular space invasion (p = 0.02) were significantly associated with the MIC and ITC. Patients with low-volume metastasis had similar disease-free survival (DFS) (92.7%) to node-negative patients (93.6%). The addition of adjuvant treatment in presence of low-volume metastasis did not modify the DFS. Conclusions: These results confirm our previous analysis of Senticol 1: the presence of low-volume metastasis did not decrease the DFS in early-stage cervical cancer patients.

From FIGO-2009 to FIGO-2018 in women with early-stage cervical cancer; Does the revised staging reflect risk groups?

“…In the present prospective study, we found that FIGO-2018 ≥ IB2 (tumor size >20 mm), proportionate depth of invasion >2/3, and immunohistochemically verified LVSI were significantly associated with nodal metastases while the absence of LVSI strongly predicted disease-free nodes. The SENTICOL study showed similar results in their univariate analyses, though only FIGO-2018 IIB and LVSI predicted lymph node metastases [30]. However, it remains controversial how this information should be translated into a clinical setting.…”

Status of Sentinel Lymph Node Biopsy in Vulvar and Cervical Cancer

“…previously negative pelvic lymph nodes underwent secondary examination by ultrastaging. In both the SENTICOL-1 and SENTICOL-2 study, a negative prognostic effect regarding progression-free survival was not detected for micrometastases or for ITC in the SLN [67,68].…”

“…Die Detektion von Mikrometastasen erfolgte hierbei retrospektiv, indem zuvor negative pelvine Lymphknoten einer sekundären Nachuntersuchung mittels Ultrastaging unterzogen wurden. Sowohl in der SENTICOL-1- als auch in der SENTICOL-2-Studie konnte weder für Mikrometastasen noch für ITC im SLN ein negativer prognostischer Einfluss hinsichtlich des progressionsfreien Überlebens festgestellt werden 67 , 68 .…”

Sentinel lymph node mapping with indocyanine green in cervical cancer patients undergoing open radical hysterectomy: a single-institution series

“…SLN has become essential part of the operative management of early-stage cervical cancer, as it provides important information on lymph nodes at highest probability of metastasis and it allows a thorough analysis of these nodes by ultrastaging (Cibula 2012 ) or OSNA (Bizzarri 2020 ). Such analysis allows to detect low-volume metastases, which represents an important information, having some authors described the negative prognostic impact of micrometastases (Kocian 2020 ); nevertheless, not all studies support the negative impact of micrometastases in cervical cancer (Guani 2020 ). Moreover, ICG has been demonstrated to be superior to other tracers alone (such as blue dye or radioactive tracers), and comparable with combination of blue and radioactive tracer in detecting SLNs in cervical cancer (Di Martino 2017 ).…”