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2022-RA-426-ESGO Stratification of lymph node metastases as macrometastases, micrometastases, or isolated tumor cells has no clinical impact in patients with cervical cancer: subgroup analysis of the SCCAN project
  1. Lukáš Dostálek1,
  2. Klára Benešová2,
  3. Jaroslav Klát3,
  4. Sarah H Kim4,
  5. Henrik Falconer5,
  6. Jan Kostun6,
  7. dos Reis Ricardo7,
  8. Ignacio Zapardiel8,
  9. David Isla Ortiz9,
  10. Luc RCW van Lonkhuijzen10,
  11. Aldo Lopez11,
  12. Diego Odetto12,
  13. Martina Borčinová1,
  14. Jiří Jarkovský2,
  15. Sahar Salehi5,
  16. Kristýna Nemejcová13,
  17. Pavel Dundr13,
  18. Kay Park14,
  19. Veronika Javůrková3,
  20. Nadeem R Abu-Rustum4 and
  21. David Cibula1
  1. 1Department of Obstetrics and Gynecology, General Teaching Hospital and The First Faculty of Medicine of Charles University, Prague, Czech Republic
  2. 2Institute of Biostatistics and Analyses, Institute 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 Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
  5. 5Department of Pelvic Cancer, Karolinska University Hospital and Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
  6. 6Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Plzen, Czech Republic
  7. 7Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Huston, TX
  8. 8Gynecologic Oncology Unit, La Paz University Hospital – IdiPAZ, Madrid, Spain
  9. 9Gynecology Oncology Center, National Institute of Cancerology Mexico, Ciudad De Mexico, Mexico
  10. 10Department of Gynecological Oncology, Amsterdam University Medical Center—Center for Gynecological Oncology Amsterdam, Amsterdam, Netherlands
  11. 11Department of Gynecological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
  12. 12Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
  13. 13Department of Pathology, General Teaching Hospital and The First Faculty of Medicine of Charles University, Prague, Czech Republic
  14. 14Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY


Introduction/Background Classification of lymph node metastases according to the size into macrometastases > 2 mm (MAC), micrometastases 0.2 – 2 mm (MIC) and isolated tumour cells <0.2 mm (ITC) was adopted from breast cancer. In cervical cancer, MAC is well established as one of the main prognostic factors, while the impact of MIC and ITC has been subject of controversy. Given the fact, that the size of nodal metastasis is a continual variable, we sought to identify a potential cut-off value for the minimal size of metastasis that is not associated with a negative prognostic impact.

Methodology Data of 967 cervical cancer patients, T1a1 L1-T2b stages, after primary surgical treatment with curative intent, including SLN biopsy followed by pathological ultrastaging, were obtained from the SCANN (Surveillance in Cervical CANcer) study. Iterative testing was performed for all subgroups of nodal metastases with upper size cut-offs ranging from 0.01 to 1.0 mm in 0.01 mm intervals. DFS in each subgroup was compared with the N0 cohort and the rest of the N1 group (> cut-off) using Log rank test.

Results When the subgroups were analyzed by the defined cut-off values, we found that disease-free survival was significantly shorter in subgroups with metastases ≥0.4 mm in diameter compared with the N0 subgroup (hazard ratio 2.311, P=.04; see figure 1a). The significance of metastases <0.4 mm could not be assessed due to limited statistical power (<80%). Also, no cut-off could be identified to separate a subcohort of small nodal metastases with significantly better prognosis than the rest of the N1 cohort (see figure 1b).

Abstract 2022-RA-426-ESGO Figure 1

Conclusion In patients with cervical cancer, the presence of lymph node metastases has a significant negative impact on disease-free survival irrespective of the size of the metastases. Traditional classification of metastases (MAC, MIC and ITC) is of no clinical value.

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