Stratification of lymph node metastases as macrometastases, micrometastases, or isolated tumor cells has no clinical implication in patients with cervical cancer: Subgroup analysis of the SCCAN project Journal Article

   

Authors:	Dostálek, L.; Benešová, K.; Klát, J.; Kim, S. H.; Falconer, H.; Kostun, J.; dos Reis, R.; Zapardiel, I.; Landoni, F.; Ortiz, D. I.; van Lonkhuijzen, L. R. C. W.; Lopez, A.; Odetto, D.; Borčinová, M.; Jarkovsky, J.; Salehi, S.; Němejcová, K.; Bajsová, S.; Park, K. J.; Javůrková, V.; Abu-Rustum, N. R.; Dundr, P.; Cibula, D.
Article Title:	Stratification of lymph node metastases as macrometastases, micrometastases, or isolated tumor cells has no clinical implication in patients with cervical cancer: Subgroup analysis of the SCCAN project
Abstract:	Background: In cervical cancer, presence of lymph-node macrometastases (MAC) is a major prognostic factor and an indication for adjuvant treatment. However, since clinical impact of micrometastases (MIC) and isolated tumor-cells (ITC) remains controversial, we sought to identify a cut-off value for the metastasis size not associated with negative prognosis. Methods: We analyzed data from 967 cervical cancer patients (T1a1L1-T2b) registered in the SCCAN (Surveillance in Cervical CANcer) database, who underwent primary surgical treatment, including sentinel lymph-node (SLN) biopsy with pathological ultrastaging. The size of SLN metastasis was considered a continuous variable and multiple testing was performed for cut-off values of 0.01–1.0 mm. Disease-free survival (DFS) was compared between N0 and subgroups of N1 patients defined by cut-off ranges. Results: LN metastases were found in 172 (18%) patients, classified as MAC, MIC, and ITC in 79, 54, and 39 patients, respectively. DFS was shorter in patients with MAC (HR 2.20, P = 0.003) and MIC (HR 2.87, P < 0.001), while not differing between MAC/MIC (P = 0.484). DFS in the ITC subgroup was neither different from N0 (P = 0.127) nor from MIC/MAC subgroups (P = 0.449). Cut-off analysis revealed significantly shorter DFS compared to N0 in all subgroups with metastases ≥0.4 mm (HR 2.311, P = 0.04). The significance of metastases <0.4 mm could not be assessed due to limited statistical power (<80%). We did not identify any cut-off for the size of metastasis with significantly better prognosis than the rest of N1 group. Conclusions: In cervical cancer patients, the presence of LN metastases ≥0.4 mm was associated with a significant negative impact on DFS and no cut-off value for the size of metastasis with better prognosis than N1 was found. Traditional metastasis stratification based on size has no clinical implication. © 2022
Keywords:	adult; controlled study; human tissue; disease-free survival; cancer surgery; major clinical study; histopathology; squamous cell carcinoma; systemic therapy; disease free survival; cancer staging; follow up; sentinel lymph node; sentinel lymph node biopsy; adenocarcinoma; classification; tumor volume; cohort analysis; retrospective study; information processing; multicenter study; uterine cervix cancer; cancer size; micrometastasis; recurrent disease; predictive value; radical hysterectomy; chemoradiotherapy; cervical cancer; isolated tumor cells; minimum inhibitory concentration; cancer prognosis; macrometastasis; prognosis; human; female; article; cervical lymph node metastasis; histopathological ultrastaging; low volume metastasis
Journal Title:	Gynecologic Oncology
Volume:	168
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2023-01-01
Start Page:	151
End Page:	156
Language:	English
DOI:	10.1016/j.ygyno.2022.11.017
PUBMED:	36442426
PROVIDER:	scopus
PMCID:	PMC10413820
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85142735042&doi=10.1016%2fj.ygyno.2022.11.017&partnerID=40&md5=69fa4f98af9d8426b5969026e0295b69
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/201866