Introduction/Background Lymph nodes micrometastases (MICs) are currently key diagnostic and treatment targets in cervical cancer (CC). There is growing evidence that MICs have the same prognostic value as macrometastases. This has implications for CC tertiary prevention approaches. The purpose of this study was to indicate how gynecologic oncologists can adapt to evolutions in tertiary prevention for MIC-positive (MIC+) CC patients.
Methodology Employing two previous studies – a meta-analysis on the prognostic role of MICs in early CC and a review of screening levels in CC prevention in Poland – we identified the need to balance following general clinical guidelines with personalized follow-up. Following PRISMA guidelines, we addressed the impact of MIC+ on prognosis of CC patients and risk control of recurrence associated with MIC+ cases. US Clinical Trials Registry, EBSCO/Ovid, ISRCTN Registry, MEDLINE/Pubmed, Cochrane databases and Google Scholar for English-language literature published over past 10 years (since 2012), with MeSH keywords ‘micrometastases’ AND ‘cervical cancer’ AND ‘follow up’ OR ‘tertiary prevention’ were analyzed. Results were graded according to the level of evidence. We presented process and critical analysis of the end data in a flow chart and algorithmic model.
Results Fifteen studies were included in this systematic review, with a total of 4700 subjects. While the MIC significantly worsens prognosis in early CC, the ITC remains unclassified. One study varied the prognosis by MIC size, but all studies followed a standard approach. A tertiary prevention algorithm stratifies follow-up by the burden of nodal disease, manages data to improve the follow-up performance, and integrates it in a useful form for clinicians by providing all the necessary information on the follow-up schedule of a patient.
Conclusion Healthcare systems should be prepared for forthcoming changes in prevention to improve the diagnosis and understanding of cancer biology and acknowledge the public health benefits of tertiary prevention.
Disclosures The Authors declare no conflict of interest.
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