Background Sentinel lymph node biopsy represents an alternative to pelvic lymphadenectomy for lymph node staging of early-stage cervical carcinoma, but prospective evidence on long-term oncological safety of sentinel lymph node biopsy alone versus pelvic lymphadenectomy is missing.
Objective To investigate, with this meta-analysis, the impact of sentinel lymph node biopsy alone versus pelvic lymphadenectomy on survival for patients with early-stage cervical cancer.
Methods A systematic literature review was performed. We excluded studies in which pelvic lymphadenectomy was systematically performed after every sentinel lymph node biopsy, including only articles where pelvic lymphadenectomy was performed because sentinel lymph node biopsy was not conclusive. A meta-analysis was carried out combining 5-year disease-free survival and overall survival rates with a random and fixed effect model. Heterogeneity was tested using the Cochran Χ2 test and quantified with Higgins information I2.
Results The search of databases and registers found 927 items and six articles (two retrospective and four prospective). The median time of follow-up was 34.8 months (range 13–53). Overall common effect disease-free survival was 98% while random effect disease-free survival was 94%. Overall heterogeneity was 77%. A subgroup analysis was applied, dividing studies into one group including sentinel lymph node biopsy negative data only (common effect disease-free survival 91%; random effect disease-free survival 90%), and one group with a negative and positive sentinel lymph node biopsy (common effect disease-free survival 98%; random effect disease-free survival 96%). In the analysis of overall survival, positive and negative sentinel lymph node biopsy cases were examined together (common and random effect overall survival 99%). Ultrastaging did not affect disease-free survival (common and random effect disease-free survival 92% in the ultrastaging group vs common effect disease-free survival 99% and random effect disease-free survival 96% in the non-ultrastaging group).
Conclusions Both 5-year disease-free survival and overall survival rate after sentinel lymph node biopsy alone are higher than 90% and do not differ from pelvic lymphadenectomy survival data. Ultrastaging did not impact survival.
- cervical cancer
- sentinel lymph node
Data availability statement
Data are available upon reasonable request.
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Collaborators Members of SENTICOL group: Uzan C. (Institut Gustave Roussy, Villejuif,France), Morice P. (Institut Gustave Roussy, Villejuif, France), Stoeckle E. (Institut Bergonié, Bordeaux, France), Querleu D. (Institut Claudius Régaud,Toulouse, France), Baron M. (Centre Henri Becquerel, Rouen, France), Ott B. (Hôpital du Hasenrain,Mulhouse, France), Darai E. (Hôpital Tenon, Paris, France), Leveque J. (Hôpital Anne de Bretagne,Rennes, France), Lanvin D. (Clinique de l’Espérance, Mougins, France), Pomel C. (Centre Jean Perrin,Clermont-Ferrand, France), Marret H. (Hôpital Bretonneau, Tours, France), Leblanc E. (Centre OscarLambret, Lille, France), Houvenaeghel G. (Institut Paoli-Calmettes, Marseille, France), Rouanet P.(Centre Val d’Aurelle, Montpellier, France), Descamps P. (CHU d’Angers, Angers, France), MageG. (CHRU de Clermont-Ferrand, Clermont-Ferrand, France), Graesslin O. (Institut Mère Enfant,Reims, France), Baldauf J.J. (Hôpital Haute Pierre, Strasbourg, France), Classe J.M. (Centre RenéGauducheau, Nantes, France), Raudrant D. (Centre hospitalier Lyon Sud, Lyon, France), ConriV. (Hôpital Pellegrin, Bordeaux, France), Douvier S. (CHU de Dijon, Dijon, France), Barranger E.(Hôpital Lariboisière, Paris, France), Leguevaque P. (Hôpital Rangueil, Toulouse, France), Fouché Y.(Centre Antoine Lacassagne, Nice, France), Boulanger L. (Hôpital Jeanne de Flandre, Lille, France),Schott AM. (Centre hospitalier Lyon Sud, Lyon, France), Bouttitie F. (Centre hospitalier Lyon Sud,Lyon, France).
Contributors The synopsis of this paper was by FRL. Paper search algorithm was performed by GP and statistical analysis were performed by XP. Data from different articles were collected with the help of papers authors VB, BG, PM. Final redaction was realized with the help of EL-F and PZ. The guarantor of this paper was FRL.
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.
Provenance and peer review Not commissioned; externally peer reviewed.