Bilateral pelvic lymphadenectomy represents the current “gold standard” for lymph node staging in cervical cancer—but an assessment of disease-free and disease-specific survival among patients with early-stage cervical cancer determined that sentinel lymph node biopsy alone is a valid standard of care. The study was presented by Vincent Balaya, MD, MSc, of Hopital Europeen Georges Pompidou, Paris, and colleagues during the Gynecologic Cancer Oral Abstract Session of the ASCO20 Virtual Scientific Program (Abstract 6006).
Vincent Balaya, MD, MSc
Researchers performed an analysis of two prospective, multicenter trials of sentinel lymph node biopsy for patients with cervical cancer (SENTICOL I and II). Patients from 30 centers in France with early-stage disease, negative sentinel lymph nodes after ultrastaging, and negative non–sentinel lymph nodes after final pathologic examination were included.
Between January 2005 and July 2012, 259 patients met the inclusion criteria: 85 patients underwent only bilateral sentinel lymph node biopsy, and 174 patients underwent bilateral pelvic lymphadenectomy. Between groups, there were no differences in histology, final FIGO stage, or surgical method. In the bilateral pelvic lymphadenectomy group, patients more frequently had tumors larger than 20 mm (22.9% vs 10.7%), and more had undergone postoperative radiochemotherapy (10.7% vs 1.6%).
The median follow-up was 47 months. During the follow-up, 21 patients (8.1%) experienced recurrences, including four nodal recurrences (1.9%), and nine patients (3.5%) died of their disease.
The 5-year disease-free survival and disease-specific survival were similar between the two groups—94.1% for patients who had undergone sentinel lymph node biopsy vs 97.7% for those who had undergone bilateral pelvic lymphadenectomy, and 88.2% vs 93.7%, respectively. After the investigators controlled for final FIGO stage and margin status, sentinel lymph node biopsy compared to bilateral pelvic lymphadenectomy was not associated with disease-free and disease-specific survival. Only final FIGO stage was an independent predictor of disease-specific survival.
In their presentation, the authors pointed out that in this population—patients with early-stage cervical cancer—the most important prognostic factor is risk assessment by Sedlis criteria, and pointed out that survival equivalence needs to be confirmed in the future by further properly designed trials.
The authors concluded, “Sentinel lymph node biopsy alone is oncologically safe in early-stage cervical cancer. Full lymphadenectomy could be omitted in case of bilateral negative sentinel lymph node biopsy. Worse prognosis was associated with higher FIGO stage disease.”
Disclosure: Dr. Balaya has received reimbursement for travel, accommodations, or other expenses from Roche. For full disclosures of the other study authors, visit coi.asco.org.