The impact of low-volume metastasis on disease-free survival of women with early-stage cervical cancer

Buda, Alessandro; Casarin, Jvan; Mueller, Michael D.; Fanfani, Francesco; Zapardiel, Ignacio; Mereu, Liliana; Puppo, Andrea; Ponti, Elena De; Adorni, Marco; Ferrari, Debora; Gasparri, Maria Luisa; Ghezzi, Fabio; Scambia, Giovanni; Papadia, Andrea

doi:10.1007/s00432-020-03435-z

Cited by 11 publications

(7 citation statements)

References 36 publications

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“…Next, 240 studies were removed because they investigated other interventions (n=169), had inadequate outcomes (n=46), and were review articles (n=25). The remaining 140 studies were selected for the final meta-analysis ( Figure 1 ), and characteristics of the eligible studies are presented in Table 1 [ 27 – 166 ].…”

Section: Resultsmentioning

confidence: 99%

Prognostic Significance of Clinicopathological Factors Influencing Overall Survival and Event-Free Survival of Patients with Cervical Cancer: A Systematic Review and Meta-Analysis

Kang

et al. 2021

Med Sci Monit

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Background Cervical cancer (CC) is the most frequent type of cancer among women and its poor prognosis is a main concern, while the prognostic factors for CC have still remained controversial. We conducted this systematic review and meta-analysis to identify the prognostic significance of clinicopathological factors, influencing overall survival (OS), and event-free survival (EFS) of CC patients. Material/Methods The electronic databases of PubMed, EmBase, and the Cochrane library were systematically searched for identification of eligible studies published until June 2021. The pooled hazard ratio (HR) with 95% confidence interval (CI) were calculated using the random-effects model. Sensitivity and subgroup analyses and assessment of publication bias were also conducted. Results We selected 140 studies that involved 47 965 patients for the meta-analysis. The results revealed that age, cell type, depth of tumor invasion, the International Federation of Gynecology and Obstetrics stage, hemoglobin level, histological grade, leukocytosis, lymph node involvement, lymph-vascular space invasion, neutrophil-to-lymphocyte ratio, parametrial invasion, platelet-to-lymphocyte ratio, resection margin, squamous cell carcinoma antigen level, thrombocytosis, tumor grade, tumor size, and tumor volume were clinicopathological factors influencing OS and EFS of CC patients ( P <0.05). Conclusions This study comprehensively identified the prognostic significance of clinicopathological factors, influencing OS, and EFS of CC patients. However, further large-scale prospective studies should be conducted to verify our findings and develop more accurate prognostic models for CC.

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Section: Resultsmentioning

confidence: 99%

Prognostic Significance of Clinicopathological Factors Influencing Overall Survival and Event-Free Survival of Patients with Cervical Cancer: A Systematic Review and Meta-Analysis

Kang

et al. 2021

Med Sci Monit

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“…No differences in risk of recurrence or death were found in patients with LVM compared with node-negative patients. Similarly, in their multicenter retrospective case–control study, Buda et al [ 13 ] evaluated the impact of LVM on DFS in 573 women with FIGO 2018 IA2-IB2 cervical cancer. In all of the centers, the same ultrastaging protocol was adopted in the pathologic processing of SLNs [ 14 ].…”

Section: Are Low-volume Metastases Clinically Meaningful? Controversi...mentioning

confidence: 99%

“…For example, among the 321 patients in the combined SENTICOL 1 and 2 population, 217 underwent a laparoscopic procedure, whereas only 21 received open surgery [ 11 ]. Similarly, 46% of patients included in Buda et al’s series [ 13 ] underwent laparoscopic radical hysterectomy.…”

Section: Are Low-volume Metastases Clinically Meaningful? Controversi...mentioning

confidence: 99%

Low-Volume Metastases in Cervical Cancer: Does Size Matter?

Bianchi,

Grassi,

Di Martino

et al. 2024

Cancers

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The implementation of sentinel lymph node (SLN) biopsy is changing the scenario in the surgical treatment of early-stage cervical cancer, and the oncologic safety of replacing bilateral pelvic lymphadenectomy with SLN biopsy is currently under investigation. Part of the undisputed value of SLN biopsy is its diagnostic accuracy in detecting low-volume metastases (LVM) via pathologic ultrastaging. In early-stage cervical cancer, the reported incidence of LVM ranges from 4 to 20%. The prognostic impact and the role of adjuvant treatment in patients with LVM is still unclear. Some non-prespecified analyses in prospective studies showed no impact on the oncologic outcomes compared to node-negative disease. However, the heterogeneity of the studies, the differences in the disease stage and the use of adjuvant treatment, and the concomitant pelvic lymphadenectomy (PLND) make reaching any conclusions on this topic hard. Current guidelines suggest considering micrometastases (MIC) as a node-positive disease, while considering isolated tumor cells (ITC) as a node-negative disease with a low level of evidence. This review aims to highlight the unanswered questions about the definition, identification, and prognostic and therapeutic roles of LVM and to underline the present and future challenges we are facing. We hope that this review will guide further research, giving robust evidence on LVM and their impacts on clinical practice.

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“…According to the new FIGO classification [ 8 ], the clinical value of micrometastasis (MIC) is the same as for the macrometastasis (MAC). However, the clinical relevance of MICs is still a matter of debate, with controversial results among the literature, especially in terms of risk of recurrence [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. The clinical impact of isolated tumor cells (ITC) remained unclear, and the presence of ITCs does not change the FIGO stage.…”

Section: Introductionmentioning

confidence: 99%

Lymph Node Involvement in Early-Stage Cervical Cancer: Is Lymphangiogenesis a Risk Factor? Results from the MICROCOL Study

Tantari

Bogliolo²,

Morotti

et al. 2022

Cancers

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Background: In patients with cervical cancer, the presence of tumoral lymph-vascular space invasion (LVSI) is the main risk factor for pelvic lymph node metastasis (PLNM). The objective of this study was to evaluate the presence of several markers of lymphangiogenesis in early-stage cervical cancer and their correlation with PLNM and tumoral recurrence. Materials and Methods: Seventy-five patients with early-stage cervical carcinoma underwent sentinel lymph node (SLN) sampling in association with complete pelvic lymph node dissection. Primary tumors were stained with the following markers: Ki67, D2-40, CD31 and VEGF-C. A 3-year follow-up was performed to evaluate the disease-free survival. Results: Overall, 14 patients (18.6%) had PLNM. Positive LVSI was seen in 29 patients (38.6%). There was a significant correlation between LVSI evidenced by H/E staining and PLNM (p < 0.001). There was no correlation between high Ki67, CD31, D2-40, and VEGF-C staining with PLNM or tumor recurrence. Conclusions: Our data support that lymphatic spread does not require the proliferation of new lymphatic endothelial cells in early-stage cervical cancer. These results emphasize the importance of pre-existing peritumoral lymphatic vessels in the metastatic process in early cervical cancer. None of the markers of lymphangiogenesis and proliferation assessed in this study were predictive of PLNM or recurrence.

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The impact of low-volume metastasis on disease-free survival of women with early-stage cervical cancer

Cited by 11 publications

References 36 publications

Prognostic Significance of Clinicopathological Factors Influencing Overall Survival and Event-Free Survival of Patients with Cervical Cancer: A Systematic Review and Meta-Analysis

Prognostic Significance of Clinicopathological Factors Influencing Overall Survival and Event-Free Survival of Patients with Cervical Cancer: A Systematic Review and Meta-Analysis

Low-Volume Metastases in Cervical Cancer: Does Size Matter?

Lymph Node Involvement in Early-Stage Cervical Cancer: Is Lymphangiogenesis a Risk Factor? Results from the MICROCOL Study

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