Martin Tiermes Marina, Castro Cristina Celada, Glickman Ariel, Carreras Nuria, Valenzuela Andrea, Fusté Pere, Saco Adela, Vidal-Sicart Sergi, Torné Aureli, Díaz-Feijoo Berta
Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic, University of Barcelona, C/Villarroel, 170, 08036, Barcelona, Spain.
Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain.
Arch Gynecol Obstet. 2025 Jul 31. doi: 10.1007/s00404-025-08134-z.
To evaluate the oncologic and survival outcomes in patients diagnosed with early-stage cervical cancer who underwent both sentinel lymph node (SLN) and pelvic lymphadenectomy (PLD) compared with those who underwent SLN alone at primary surgery.
From 2001 to 2022, women who underwent SLN biopsy for nodal staging were recruited. The group of women who underwent SLN biopsy and PLD (SLN + PLD group) was compared with the group who underwent SLN mapping alone (SLN group).
210 patients were evaluated (98 and 112 in each group). The overall SLN detection rate was 97.6%. Lymph node involvement was detected in 23 patients (11%), and the rate of positive SLN increased from 6.2 to 11% after final pathological examination. At a median follow-up of 80 months, the recurrence and mortality rates were 6.2 and 2.4%, respectively. The 3-year progression-free survival (PFS) rate was 93.7 and 97.2%, and the overall survival (OS) rate was 98.9 and 99.0% in the SLN + PLD and SLN group, respectively. There were no significant differences in the Kaplan-Meier PFS (p = 0.471; HR 0.66; 95% CI 0.22-2.04) and OS (p = 0.228; HR 0.28; 95% CI 0.03-2.53) curves between the groups.
Pending further confirmation from prospective trials, SLN biopsy appears to be an effective method of nodal assessment in early-stage cervical cancer. This technique does not appear to increase the risk of recurrence compared with complete PLD in selected patients and may offer a viable, less invasive alternative for accurate nodal staging.
评估在初次手术时既接受前哨淋巴结（SLN）活检又接受盆腔淋巴结清扫术（PLD）的早期宫颈癌患者与仅接受SLN活检的患者的肿瘤学及生存结局。
纳入2001年至2022年期间接受SLN活检以进行淋巴结分期的女性。将接受SLN活检及PLD的女性组（SLN + PLD组）与仅接受SLN定位的组（SLN组）进行比较。
共评估了210例患者（每组98例和112例）。总体SLN检出率为97.6%。23例患者（11%）检测到淋巴结受累，最终病理检查后阳性SLN率从6.2%升至11%。中位随访80个月时，复发率和死亡率分别为6.2%和2.4%。SLN + PLD组和SLN组的3年无进展生存率（PFS）分别为93.7%和97.2%，总生存率（OS）分别为98.9%和99.0%。两组之间的Kaplan-Meier PFS曲线（p = 0.471；HR 0.66；95% CI 0.22 - 2.04）和OS曲线（p = 0.228；HR 0.28；95% CI 0.03 - 2.53）无显著差异。
在前瞻性试验进一步证实之前，SLN活检似乎是早期宫颈癌淋巴结评估的有效方法。与选定患者进行完整的PLD相比，该技术似乎不会增加复发风险，并且可能为准确的淋巴结分期提供一种可行的、侵入性较小的替代方法。
