Bizzarri Nicolò, Fedele Camilla, Teodorico Elena, Certelli Camilla, Pedone Anchora Luigi, Carbone Vittoria, Giannarelli Diana, Fagotti Anna, Zannoni Gian Franco, Valente Michele, Querleu Denis, Ferrandina Gabriella, Scambia Giovanni, Fanfani Francesco
UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
Eur J Surg Oncol. 2024 Apr;50(4):108250. doi: 10.1016/j.ejso.2024.108250. Epub 2024 Mar 5.
Sentinel lymph node (SLN) biopsy is part of surgical treatment of apparent early-stage cervical cancer. SLN is routinely analyzed by ultrastaging and immunohistochemistry. The aim of this study was to assess the survival of patients undergoing SLN analyzed by one-step nucleic acid amplification (OSNA) compared with ultrastaging.
Single-center, retrospective, cohort study. Patients undergoing primary surgery and SLN mapping ( ±pelvic lymphadenectomy) for apparent early-stage cervical cancer between May 2017 and January 2021 were included. SLN was analyzed exclusively with OSNA or with ultrastaging. Patients with bilateral SLN mapping failure, with SLN analyzed alternatively/serially with OSNA and ultrastaging, and undergoing neo-adjuvant therapy were excluded. Baseline clinic-pathological differences between the two groups were balanced with propensity-match analysis.
One-hundred and fifty-seven patients were included, 50 (31.8%) in the OSNA group and 107 (68.2%) in the ultrastaging group. Median follow up time was 41 months (95%CI:37.9-42.2). 5-year DFS in patients undergoing OSNA versus ultrastaging was 87.0% versus 91.0% (p = 0.809) and 5-year overall survival was 97.9% versus 98.6% (p = 0.631), respectively. No difference in the incidence of lymph node recurrence between the two groups was noted (OSNA 20.0% versus ultrastaging 18.2%, p = 0.931). In the group of negative SLN, no 5-year DFS difference was noted between the two groups (p = 0.692). No 5-year DFS and OS difference was noted after propensity-match analysis (87.6% versus 87.0%, p = 0.726 and 97.4% versus 97.9%, p = 0.998, respectively).
The use of OSNA as method to exclusively process SLN in cervical cancer was not associated with worse DFS compared to ultrastaging. Incidence of lymph node recurrence in the two groups was not different.
前哨淋巴结（SLN）活检是早期宫颈癌手术治疗的一部分。SLN通常通过超分期和免疫组织化学进行分析。本研究的目的是评估与超分期相比，采用一步核酸扩增（OSNA）分析SLN的患者的生存率。
单中心回顾性队列研究。纳入2017年5月至2021年1月期间因早期宫颈癌接受初次手术和SLN定位（±盆腔淋巴结清扫术）的患者。SLN仅采用OSNA或超分期进行分析。排除双侧SLN定位失败、SLN交替/连续采用OSNA和超分期分析以及接受新辅助治疗的患者。通过倾向匹配分析平衡两组之间的基线临床病理差异。
共纳入157例患者，OSNA组50例（31.8%），超分期组107例（68.2%）。中位随访时间为41个月（95%CI：37.9 - 42.2）。采用OSNA与超分期分析的患者5年无病生存率分别为87.0%和91.0%（p = 0.809），5年总生存率分别为97.9%和98.6%（p = 0.631）。两组之间淋巴结复发率无差异（OSNA组20.0%，超分期组18.2%，p = 0.931）。在SLN阴性组中，两组之间5年无病生存率无差异（p = 0.692）。倾向匹配分析后5年无病生存率和总生存率无差异（分别为87.6%和87.0%，p = 0.726；97.4%和97.9%，p = 0.998）。
与超分期相比，采用OSNA作为唯一处理宫颈癌SLN的方法与较差的无病生存率无关。两组之间淋巴结复发率无差异。
