Alessandro Buda1, Jvan Casarin2, Michael Mueller3, Francesco Fanfani4,5, Ignacio Zapardiel6, Liliana Mereu7, Andrea Puppo8, Elena De Ponti9, Marco Adorni10, Debora Ferrari10, Maria Luisa Gasparri11, Fabio Ghezzi2, Giovanni Scambia4,5, Andrea Papadia3,11. 1. Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. alebuda1972@gmail.com. 2. Obstetrics and Gynecology Department, University of Insubria, Varese, Italy. 3. Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland. 4. Dipartimento della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 5. Dipartimento Scienze della vita e sanità pubblica, Sacred Heart Catholic University, Rome, Italy. 6. Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain. 7. Department of Obstetrics and Gynecology, Santa Chiara Hospital, Trento, Italy. 8. Clinic of Obstetrics and Gynecology, Santa Croce e Carle Hospital, Cuneo, Italy. 9. Department of Physical Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. 10. Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. 11. Department of Gynecology and Obstetrics, University of the Italian Switzerland (USI), Ente Ospedaliero Cantonale of Lugano, Lugano, Switzerland.
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.
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.
Authors: Beatrice Cormier; John P Diaz; Karin Shih; Rachael M Sampson; Yukio Sonoda; Kay J Park; Khaled Alektiar; Dennis S Chi; Richard R Barakat; Nadeem R Abu-Rustum Journal: Gynecol Oncol Date: 2011-05-13 Impact factor: 5.482
Authors: D Cibula; M Zikan; J Slama; D Fischerova; R Kocian; A Germanova; A Burgetova; L Dusek; P Dundr; M Gregova; K Nemejcova Journal: Gynecol Oncol Date: 2016-07-12 Impact factor: 5.482
Authors: L Dostálek; M Zikan; D Fischerova; R Kocian; A Germanova; F Frühauf; L Dusek; J Slama; P Dundr; K Nemejcova; D Cibula Journal: Gynecol Oncol Date: 2018-02-01 Impact factor: 5.482
Authors: D Cibula; N R Abu-Rustum; L Dusek; M Zikán; A Zaal; L Sevcik; G G Kenter; D Querleu; R Jach; A S Bats; G Dyduch; P Graf; J Klat; J Lacheta; C J L M Meijer; E Mery; R Verheijen; R P Zweemer Journal: Gynecol Oncol Date: 2011-11-25 Impact factor: 5.482
Authors: Nadeem R Abu-Rustum; Kaled Alektiar; Alexia Iasonos; Gali Lev; Yukio Sonoda; Carol Aghajanian; Dennis S Chi; Richard R Barakat Journal: Gynecol Oncol Date: 2006-06-05 Impact factor: 5.482
Authors: Giampaolo Di Martino; Cinzia Crivellaro; Elena De Ponti; Beatrice Bussi; Andrea Papadia; Ignacio Zapardiel; Enrico Vizza; Federica Elisei; Maria Dolores Diestro; Luca Locatelli; Maria Luisa Gasparri; Paolo Di Lorenzo; Michael Mueller; Alessandro Buda Journal: J Minim Invasive Gynecol Date: 2017-05-29 Impact factor: 4.137
Authors: David Cibula; J Dusek; J Jarkovsky; P Dundr; D Querleu; A van der Zee; A Kucukmetin; R Kocian Journal: Int J Gynecol Cancer Date: 2019-01 Impact factor: 3.437