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Cervical cancer
898 The impact of micrometastases in cervical cancer patients – a retrospective study of the SCCAN (Surveillance in Cervical CANcer) project
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  1. L Dostalek1,
  2. M Borcinova1,
  3. K Benesova2,
  4. J Klat3,
  5. H Falconer4,
  6. SH Kim5,
  7. LR Van Lonkhuijzen6,
  8. A Lopez7,
  9. D Isla Ortiz8,
  10. F Landoni9,
  11. J Kostun10,
  12. R Dos Reis11,
  13. D Odetto12,
  14. I Zapardiel13,
  15. J Jarkovsky2,
  16. V Javukova3,
  17. S Salehi4,
  18. NR Abu-Rustum5,
  19. P Graf3 and
  20. D Cibula1
  1. 1Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, (CEEGOG), Prague, Czech Republic
  2. 2Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
  3. 3Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital and University of Ostrava, Ostrava , Czech Republic
  4. 4Department of Pelvic Cancer, Karolinska University Hospital and Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
  5. 5Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
  6. 6Department of Gynecological Oncology, Amsterdam University Medical Center—Center for Gynecological Oncology Amsterdam, Amsterdam, the Netherlands
  7. 7Department of Gynecological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
  8. 8Gynecology Oncology Center, National Institute of Cancerology Mexico, Mexico
  9. 9University of Milano-Bicocca,Department of Obstetrics and Gynecology, Gynaecologic Oncology Surgical Unit, ASST-Monza, San Gerardo Hospital, Monza, Italy
  10. 10Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Prague, Czech Republic
  11. 11Departamento de Ginecologia Oncológica, Hospital de Amor – Barretos, Brazil
  12. 12Department of Gynecologic Oncology , Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano , Buenos Aires , Argentina
  13. 13Gynecologic Oncology Unit, La Paz University Hospital – IdiPAZ, Madrid, Spain

Abstract

Introduction/Background*The impact of lymph node (LN) micrometastases (MIC) in cervical cancer patients remains a controversial topic given their low incidence and good prognosis of patients managed by primary surgery.

We aim to evaluate the prognostic significance of MIC and isolated tumour cells (ITC) in a large cohort of patients from the SCCAN retrospetive study (Surveillance in Cervical CANcer). SCCAN study analysed data from more than 4300 patients with early stage cervical cancer treated by primary surgery at 20 large tertiary institutions from Europe, North America, South America and Australia.

Methodology In this SCCAN sub-study, we included patients with early stage cervical cancer (T1a1 LVSI+ – T2b) treated between 2007 and 2016 with at least 1-year follow-up data availability, who underwent primary surgery including sentinel lymph node (SLN) biopsy and in whom SLNs were processed by pathological ultrastaging protocol.

Result(s)*Out of 969 included patients with at least 1 SLN detected, 174 (18%) had positive LN (table 1). Maximal tumour diameter >2cm, positive LVSI, grade ≥ 2, uncommon histological type (neuroendocrine, sarcoma, etc.) and macrometstasis (MAC) or MIC in LN were factors associated with significantly decreased five-years disease free survival (DFS) (table 2). MAC, MIC or ITC was the largest LN metastasis in 84 (9%), 59 (6%) and 31 (3%) cases respectively. Adjuvant (chemo)radiation was administred in 89%, 85% and 58% of patients with MAC, MIC and ITC. DFS reached 75%, 73% and 83% in patients with MAC, MIC and ITC compared with 90% in the N0 patients. Patients with MAC and MIC had significantly decreased DFS than those with N0 disease (HR=2.36 and 2.55).

Abstract 898 Figure 1
Abstract 898 Figure 1
View this table:
Abstract 898 Table 1

Data summary (N = 969)

View this table:
Abstract 898 Table 2

Univariate analysis of factors associated with disease-free survival (N = 969)

Conclusion*Early-stage cervical cancer patients with MIC in pelvic LN have significantly decreased DFS. Their management should follow the same principles as in patients with MAC.

https://doi.org/10.1136/ijgc-2021-ESGO.74

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