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Does small volume metastatic lymph node disease affect long-term prognosis in early cervical cancer?
  1. Andra Nica1,
  2. Lilian T Gien2,
  3. Sarah Elizabeth Ferguson3 and
  4. Allan Covens2
  1. 1Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada
  2. 2Gynecologic Oncology, Toronto Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
  3. 3Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Allan Covens, Gynecologic Oncology, Toronto Sunnybrook Regional Cancer Center, Toronto, ON M4N 3M3, Canada; al.covens{at}sunnybrook.ca

Abstract

Introduction As sentinel lymph node biopsy is evolving to an accepted standard of care, clinicians are being faced with more frequent cases of small volume nodal metastatic disease. The objective of this study is to describe the management and to measure the effect on recurrence rates of nodal micrometastasis and isolated tumor cells in patients with early stage cervical cancer at two high-volume centers.

Methods We conducted a review of prospectively collected patients with surgically treated cervical cancer who were found to have micrometastasis or isolated tumor cells on ultrastaging of the sentinel lymph node. Our practice is to follow patients for ≥5 years post-operatively either at our center or another cancer center closer to home.

Results Nineteen patients with small volume nodal disease were identified between 2006 and 2018. Median follow-up was 62 months. Ten (53%) had nodal micrometastatic disease, while nine (47%) had isolated tumor cells detected in the sentinel lymph node. Seven patients (37%) underwent completion pelvic lymphadenectomy and four of them also had para-aortic lymphadenectomy; there were no positive non-sentinel lymph nodes. The majority (74%) received adjuvant treatment, mostly driven by tumor factors. We observed two recurrences. Recurrence-free survival was comparable with historical cohorts of node negative patients, and adjuvant treatment did not seem to impact the recurrence rate (p=0.5).

Conclusion Given the uncertainties around the prognostic significance of small volume nodal disease in cervical cancer, a large proportion of patients receive adjuvant treatment. We found no positive non-sentinel lymph nodes, suggesting that pelvic lymphadenectomy or para-aortic lymphadenectomy may not be of benefit in patients diagnosed with small volume nodal metastases. Recurrence-free survival in this group did not seem to be affected. However, given the small numbers of patients and lack of level 1 evidence, decisions should be individualized in accordance with patient preferences and tumor factors.

  • cervical cancer
  • neoplasm micrometastasis
  • sentinel lymph node
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Footnotes

  • Editor's note This paper will feature in a special issue on sentinel lymph node mapping in 2020.

  • Contributors AN performed data collection, analysis and wrote the manuscript. LTG and SEF were involved in the surgical treatment of patients and manuscript editing. AC is the senior author, involved in the surgical treatment of patients and also responsible for the study idea, and for supervising data collection, analysis, and manuscript editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Deidentified participant data is securely stored by the first and the corresponding authors. Available upon reasonable request.

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