The impact of low-volume metastasis on disease-free survival of women with early-stage cervical cancer
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ORIGINAL ARTICLE – CANCER RESEARCH
The impact of low‑volume metastasis on disease‑free survival of women with early‑stage cervical cancer Alessandro Buda1 · Jvan Cesarin2 · Michael Mueller3 · Francesco Fanfani4,5 · Ignacio Zapardiel6 · Liliana Mereu7 · Andrea Puppo8 · Elena De Ponti9 · Marco Adorni1 · Debora Ferrari1 · Maria Luisa Gasparri10 · Fabio Ghezzi2 · Giovanni Scambia4,5 · Andrea Papadia3,10 Received: 6 September 2020 / Accepted: 21 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose We aimed to assess the impact of low-volume metastasis (micrometastasis and isolated tumor cells) on disease-free survival (DFS) of women with early-stage cervical cancer. Methods Women with clinically suspected stage 1A-IB2 (FIGO 2018 classification) disease who underwent retroperitoneal nodal staging between October 2010 and April 2018, were retrospectively analyzed. The group of women who had undergone lymphadenectomy and standard node pathologic analysis (H&E group), were compared to the group undergoing sentinel node mapping (SLN) and ultrastaging with or without lymphadenectomy (ultrastaging group). At a median follow-up of 45 months, the DFS curves were analyzed. Results Overall, 573 patients were revised (272 in the H&E group and 302 in the ultrastaging group). Eighty-five patients presented lymph node metastasis (32 in H&E, 53 in ultrastaging). Ultrastaging protocol increased the rate of low-volume metastasis by 5.6%. Twenty patients showed exclusive micrometastasis or ITC’s. Seventy-three recurrences occurred (35 in H&E, 38 in ultrastaging). Only 1 out of 53 patients in the ultrastaging group (1.9%) presented with micrometastasis recurred. The 3-year disease-free survival was 89% for the H&E group, and 88% for the ultrastaging group, respectively (p = 0.175). Conclusion Ultrastaging analysis allowed increasing the detection of low volume metastasis in women with early-stage cervical cancer. However, the type of nodal staging did not have an impact on patients’ 3-year disease-free survival. Keywords Sentinel node · Cervical cancer · Low volume metastases · Progression-free survival
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Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain
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Department of Obstetrics and Gynecology, Santa Chiara Hospital, Trento, Italy
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Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
Clinic of Obstetrics and Gynecology, Santa Croce e Carle Hospital, Cuneo, Italy
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Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
Department of Physical Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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* Alessandro Buda [email protected] 1
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Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Dipartimento della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Dipart
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