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@article{2247611, author = {Dostalek, Lukas and Benešová, Klára and Klat, Jaroslav and Kim, Sarah H and Falconer, Henrik and Kostun, Jan and Ricardo, dos Reis and Zapardiel, Ignacio and Landoni, Fabio and Ortizj, David Isla and van Lonkhuijzen, Luc R C W and Lopez, Aldo and Odetto, Diego and Borcinova, Martina and Jarkovský, Jiří and Salehi, Sahar and Nemejcova, Kristyna and Bajsova, Sylva and Park, Kay J and Javurkova, Veronika and AbuandRustum, Nadeem R and Dundr, Pavel and Cibula, David}, article_location = {SAN DIEGO}, article_number = {January 2023}, doi = {http://dx.doi.org/10.1016/j.ygyno.2022.11.017}, keywords = {Micrometastasis; Cervical cancer; Low volume metastasis; Disease-free survival; Histopathological ultrastaging; Isolated tumor cells; Sentinel lymph node; Macrometastasis; Classification; Prognosis}, language = {eng}, issn = {0090-8258}, journal = {Gynecologic Oncology}, title = {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}, url = {https://www.sciencedirect.com/science/article/pii/S0009898122014279}, volume = {168}, year = {2023} }
TY - JOUR ID - 2247611 AU - Dostalek, Lukas - Benešová, Klára - Klat, Jaroslav - Kim, Sarah H - Falconer, Henrik - Kostun, Jan - Ricardo, dos Reis - Zapardiel, Ignacio - Landoni, Fabio - Ortizj, David Isla - van Lonkhuijzen, Luc R C W - Lopez, Aldo - Odetto, Diego - Borcinova, Martina - Jarkovský, Jiří - Salehi, Sahar - Nemejcova, Kristyna - Bajsova, Sylva - Park, Kay J - Javurkova, Veronika - Abu-Rustum, Nadeem R - Dundr, Pavel - Cibula, David PY - 2023 TI - 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 JF - Gynecologic Oncology VL - 168 IS - January 2023 SP - 151-156 EP - 151-156 PB - ACADEMIC PRESS INC ELSEVIER SCIENCE SN - 00908258 KW - Micrometastasis KW - Cervical cancer KW - Low volume metastasis KW - Disease-free survival KW - Histopathological ultrastaging KW - Isolated tumor cells KW - Sentinel lymph node KW - Macrometastasis KW - Classification KW - Prognosis UR - https://www.sciencedirect.com/science/article/pii/S0009898122014279 N2 - 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 < 0.001), while not differing between MAC/MIC (P = 0.484). DFS in the ITC subgroup was neither different from N0 (P = 0.127) nor from MIC/MAC subgroups (P = 0.449). Cut-off analysis revealed significantly shorter DFS com-pared to N0 in all subgroups with metastases >= 0.4 mm (HR 2.311, P = 0.04). The significance of metastases <0.4 mm could not be assessed due to limited statistical power (<80%). We did not identify any cut-off for the size of metastasis with significantly better prognosis than the rest of N1 group.Conclusions. In cervical cancer patients, the presence of LN 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. ER -
DOSTALEK, Lukas, Klára BENEŠOVÁ, Jaroslav KLAT, Sarah H KIM, Henrik FALCONER, Jan KOSTUN, dos Reis RICARDO, Ignacio ZAPARDIEL, Fabio LANDONI, David Isla ORTIZJ, Luc R C W VAN LONKHUIJZEN, Aldo LOPEZ, Diego ODETTO, Martina BORCINOVA, Jiří JARKOVSKÝ, Sahar SALEHI, Kristyna NEMEJCOVA, Sylva BAJSOVA, Kay J PARK, Veronika JAVURKOVA, Nadeem R ABU-RUSTUM, Pavel DUNDR and David CIBULA. 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. \textit{Gynecologic Oncology}. SAN DIEGO: ACADEMIC PRESS INC ELSEVIER SCIENCE, 2023, vol.~168, January 2023, p.~151-156. ISSN~0090-8258. Available from: https://dx.doi.org/10.1016/j.ygyno.2022.11.017.
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