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 associ-ated with negative prognosis.Methods. We analyzed data from 967 cervical cancer patients (T1a1L1-T2b) registered in the SCCAN (Surveil-lance 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 be-tween 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 pa-tients, respectively. DFS was shorter in patients with MAC (HR 2.20, P = 0.003) and MIC (HR 2.87, P = 0.4 mm (HR 2.311, P = 0.04).
The significance of metastases = 0.4 mm was associated with a signif-icant 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.