P26\u2005Micrometastasis in sentinel lymph nodes is a significant negative prognostic marker in early-stage cervical cancer

Abstract

Introduction/Background Since the risk of recurrence is low in early-stage cervical cancer, any assessment of prognostic importance of micrometastases (MIC) requires a large cohort. The aim of the study was to retrospectively analyze a large group of patients treated at a single site where sentinel lymph node (SLN) has been used in the management of cervical cancer since 2004 and which has an intensive protocol for SLN pathological ultrastaging. Methodology Patients with stage T1a - T2b cervical cancer treated by primary surgery with curative intent, who had common tumor types, at least unilateral SLN detection, and who were treated between 01/2007 - 12/2016 were included in the study. Radical surgery was abandoned if metastasis in SLN was detected by frozen section. All SLN were processed by an intensive protocol for SLN ultrastaging (entire SLN processed, 2 sections (H&E/cytokeratin) in 150 µm intervals from each block). Results The analysis included data from 234 patients (table 1). Adjuvant treatment was given to 79% of patients with macrometastasis (MAC), 77% with MIC, and 11% with isolated tumor cells (ITC). Within the median follow-up of 67 months 29 recurrences occurred. The recurrence rate of patients with negative LN, with MAC, MIC or ITC reached 9%, 29%, 35% and 22% respectively. Table 2 shows parameters significant for the risk of recurrence. Kaplan-Meier curves for PFS were significantly different for cases with MAC and MIC in comparison to LN-negative cases (figure 1). Conclusion The presence of MIC in SLN was associated with significantly decreased PFS, similar to MAC. There was a similar trend for ITC, but it did not reach significance due to low numbers. Patients with MIC and MAC should be managed identically and SLN ultrastaging should become an integral part of the management of patients with early-stage cervical cancer. Disclosure Acknowledgements This work was supported by Charles University in Prague (UNCE 204065 and PROGRES Q28/LF1) and by a grant from the Czech Research Council (No 16-31643A). None of the authors declare any conflict of interest. Abstract P26 Table 1 Characteristics of the group Age (years), BMI 41.8 (26.3; 68.1), 24.3 (18.5; 36.3) Stage pT (pathology) 1a1, 1a2, 1b1, 1b2, 2a1 9 (3.8%), 7 (3.0%), 159 (67.9%), 33 (14.1%), 25 (10.7%) Tumor type Adenocarcinoma, Adenosquamous, Squamous 51 (21.8%), 7 (3.0%), 170 (72.6%) Grade 1, 2, 3, missing 21 (9.0%), 96 (41.0%), 97 (41.5%), 20 (8.5%) LVSI, FST, Number of LN per patient lymphovascular space invasion, fertility sparing treatment 100 (42.7%), 29 (12.4.%), 36.0 (4.0;59.5) Type of parametrectomy B, C1, C2, simple hyst/trachel. 13 (5.6%), 110 (47.1%), 94 (38.2%), 25 (10.6%) Type of positivity MAC, MIC, ITC, Negative 14 (6.0%), 17 (7.3.%), 9 (3.8%), 194 (82.9%) Adjuvant treatment 36 (15.4%) Follow up length (months) 67.6 (8.65;127.86) Recurrence 29 (12.4%) Abstract P26 Table 2 Significant parameters for the risk of recurrence/death from univariate analysis Abstract P26 Figure 1 Kaplan - Meier model for progression free survival according to the type of LN involvement