Lymph Node Micrometastases in Early-Stage Cervical Cancer are Not Predictive of Survival

Abstract

Although patients with early-stage cervical cancer have in general a favorable prognosis, 10% to 40% patients still recur depending on pathologic risk factors. The objective of this study was to evaluate if the presence of lymph node micrometastasis (LNmM) had an impact on patient's survival. We performed a multi-institutional retrospective review on patients with early-stage cervical cancer, with histologically negative lymph nodes, treated with radical hysterectomy and pelvic lymphadenectomy for the study period 1994 to 2004. Tissue blocks of lymph nodes from the patient's original surgery were recut and then evaluated for the presence of micrometastases. One hundred twenty-nine patients were identified who met inclusion criteria. LNmM were found in 26 patients (20%). In an average follow-up time of 70 mo, there were 11 recurrences (8.5%). Of the 11 recurrences, 2 (18%) patients had LNmM. Patients with LNmM were more likely to have received adjuvant radiation and chemotherapy. In stratified log-rank analysis, LNmM were not associated with any other high-risk clinical or pathologic variables. Survival data analysis did not demonstrate an association between the presence of LNmM and recurrence or overall survival. The presence of LNmM was not associated with an unfavorable prognosis nor was it associated with other high-risk clinical or pathologic variables predicting recurrence. Further study is warranted to understand the role of micrometastases in cervical cancer.

Outcomes of pre-operative brachytherapy followed by hysterectomy for early cervical cancer

“…Furthermore, imaging-based staging using MRI, CT, and/or positron emission tomography coupled with CT remains inferior to surgical assessment of lymph node status 29. The pelvic lymphadenectomy revealed micrometastasis in eight patients (10%), although we did not perform adjuvant treatment targeting the pelvis after brachytherapy and hysterectomy because of its unclear effects on patient outcomes 30 31…”

Does small volume metastatic lymph node disease affect long-term prognosis in early cervical cancer?

“…A recent prospective study where patients underwent sentinel lymph node biopsy followed by confirmatory pelvic lymphadenectomy showed no impact on recurrence-free survival at 36 months; 12 of the 13 patients with small volume nodal disease did not receive any adjuvant treatment 9. Previous retrospective studies5 10–15 have included patients who had sentinel lymph node biopsy followed by pelvic lymphadenectomy, and have had conflicting results. Nodal micrometastases have been associated with decreased overall survival and increased recurrence in patients with cervical cancer in some studies5 10 13–15 but not in others 9 11.…”

“…Previous retrospective studies5 10–15 have included patients who had sentinel lymph node biopsy followed by pelvic lymphadenectomy, and have had conflicting results. Nodal micrometastases have been associated with decreased overall survival and increased recurrence in patients with cervical cancer in some studies5 10 13–15 but not in others 9 11. Patients with nodal sub-micrometastases in breast cancer (≤0.2 mm) and in melanoma (≤0.1 mm) have the same prognosis as node negative patients 16–19.…”

Leitlinienbasierte Aufarbeitung und Befundung von Lymphonodektomiepräparaten und Sentinel-Lymphknoten gynäkologischer Malignome

“…Die metrische Größenausdehnung von Lymphknotenmetastasen ist beim Vulva-und Ovarialkarzinom stagingrelevant [51]. Beim Zervixkarzinom gibt es Hinweise auf die prognostische Bedeutung der Unterscheidung zwischen Mikro-und Makrometastasen [19,43].…”