Kocian Roman, Slama Jiri, Fischerova Daniela, Germanova Anna, Burgetova Andrea, Dusek Ladislav, Dundr Pavel, Nemejcova Kristyna, Jarkovsky Jiri, Sebestova Silvie, Fruhauf Filip, Dostalek Lukas, Ballaschova Tereza, Cibula David
Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 128 00 Prague, Czech Republic.
Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 128 00 Prague, Czech Republic.
Cancers (Basel). 2020 May 31;12(6):1438. doi: 10.3390/cancers12061438.
The data on the prognostic significance of low volume metastases in lymph nodes (LN) are inconsistent. The aim of this study was to retrospectively analyze the outcome of a large group of patients treated with sentinel lymph node (SLN) biopsy at a single referral center. Patients with cervical cancer, stage T1a-T2b, common tumor types, negative LN on preoperative staging, treated by primary surgery between 01/2007 and 12/2016, with at least unilateral SLN detection were included. Patients with abandoned radical surgery due to intraoperative SLN positivity detected by frozen section were excluded. All SLNs were postoperatively processed by an intensive protocol for pathological ultrastaging. Altogether, 226 patients were analyzed. Positive LN were detected in 38 (17%) cases; macrometastases (MAC), micrometastases (MIC), isolated tumor cells (ITC) in 14, 16, and 8 patients. With the median follow-up of 65 months, 22 recurrences occurred. Disease-free survival (DFS) reached 90% in the whole group, 93% in LN-negative cases, 89% in cases with MAC, 69% with MIC, and 87% with ITC. The presence of MIC in SLN was associated with significantly decreased DFS and OS. Patients with MIC and MAC should be managed similarly, and SLN ultrastaging should become an integral part of the management of patients with early-stage cervical cancer.
关于淋巴结（LN）中低体积转移灶的预后意义的数据并不一致。本研究的目的是回顾性分析在单一转诊中心接受前哨淋巴结（SLN）活检的一大组患者的预后情况。纳入2007年1月至2016年12月期间接受初次手术治疗、宫颈癌分期为T1a - T2b、常见肿瘤类型、术前分期LN阴性且至少检测到单侧SLN的患者。因术中冰冻切片检测到SLN阳性而放弃根治性手术的患者被排除。所有SLN术后均按照强化方案进行病理超分期处理。总共分析了226例患者。38例（17%）检测到阳性LN；14例、16例和8例患者分别出现大转移灶（MAC）、微转移灶（MIC）、孤立肿瘤细胞（ITC）。中位随访65个月，发生22例复发。全组无病生存率（DFS）为90%，LN阴性病例为93%，MAC病例为89%，MIC病例为69%，ITC病例为87%。SLN中存在MIC与DFS和总生存期（OS）显著降低相关。MIC和MAC患者应采取相似的治疗策略，SLN超分期应成为早期宫颈癌患者治疗的一个组成部分。
