Survival associated with the use of sentinel lymph node in addition to lymphadenectomy in early-stage cervical cancer treated with surgery alone: A sub-analysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study

Nicolò Bizzarri ¹, Denis Querleu ¹, Pedro T Ramirez ²

¹UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
²Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA.
³Gynecologic 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.
⁴Center for Gynaecologic Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
⁵Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
⁶Department of Gynecological Surgery, National Institute of Neoplastic Diseases, Lima, Peru.
⁷Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
⁸Baskent University School of Medicine, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Ankara, Turkey.
⁹Memorial Sloan Kettering Cancer Center, New York, USA.
¹⁰Gynecology Oncology Center, National Institute of Cancerology Mexico, Mexico City, Mexico.
¹¹Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital and University of Ostrava, Ostrava, Czech Republic.
¹²IRCCS Fondazione San Gerardo - Università Milano Bicocca, Monza, Italy.
¹³Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia.
¹⁴Wolfson Institute of Population Health, Barts Cancer Centre, Queen Mary University of London, & Barts Health NHS Trust, London, UK; Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK; Department of Health Services Research | Faculty of Public Health & Policy | London School of Hygiene & Tropical Medicine, London, UK.
¹⁵Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Prague, Czech Republic.
¹⁶Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health and Research Hospital, University of Health Sciences, Ankara, Turkey.
¹⁷Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina.
¹⁸Gynecology, Medical University of Graz, Graz, Austria.
¹⁹Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain.
²⁰University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic.
²¹Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil.
²²Oncology Unit of the Cayetano Heredia Hospital, Lima, Peru.

⁰UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.

European Journal of Cancer +

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September 13, 2024

View abstract on PubMed

Summary

Sentinel lymph node (SLN) biopsy combined with pelvic lymphadenectomy improves survival outcomes for early-stage cervical cancer patients. This approach reduces recurrence and death rates, enhancing 5-year disease-free survival (DFS) through more accurate nodal metastasis detection.

Area Of Science

Gynecologic Oncology
Surgical Pathology
Clinical Cancer Research

Background

Early-stage cervical cancer management often involves surgical staging.
Accurate assessment of lymph node involvement is critical for treatment planning and prognosis.
Sentinel lymph node (SLN) biopsy is an evolving technique for staging nodal disease.

Purpose Of The Study

To evaluate if sentinel lymph node (SLN) biopsy, in addition to lymphadenectomy, improves survival in early-stage cervical cancer.
To compare recurrence and survival rates between patients who underwent SLN biopsy plus lymphadenectomy versus lymphadenectomy alone.

Main Methods

International, multicenter, retrospective study of 1083 patients with early-stage cervical cancer (FIGO 2009 stage IB1-IIA2).
Patients underwent surgery with negative margins via laparotomy.
Lymph node assessment involved either SLN biopsy with ultrastaging plus pelvic lymphadenectomy (SLN group) or pelvic lymphadenectomy alone (non-SLN group).

Main Results

The SLN group (300 patients) showed significantly lower recurrence rates (3.7% vs. 8.4%) and death rates (1.3% vs. 3.8%) compared to the non-SLN group (783 patients).
Five-year disease-free survival (DFS) was significantly better in the SLN group (96.0% vs. 92.0%).
Pelvic central recurrence rates were higher in the non-SLN group (4.5% vs. 1.7%).

Conclusions

Sentinel lymph node (SLN) biopsy addition to pelvic lymphadenectomy is associated with reduced recurrence and mortality rates.
The improved DFS in the SLN group may be attributed to enhanced detection of nodal metastases via SLN ultrastaging.
SLN biopsy is recommended for staging patients with early-stage cervical cancer.

Keywords:

Cervical cancer Lymphadenectomy Recurrence Sentinel lymph node Survival Ultrastaging

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