MILACC study: could undetected lymph node micrometastases have impacted recurrence rate in the LACC trial?

. 2023 Nov 06 ; 33 (11) : 1684-1689. [epub] 20231106

Jazyk angličtina Země Spojené státy americké Médium electronic

Typ dokumentu randomizované kontrolované studie, časopisecké články, Research Support, N.I.H., Extramural, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/pmid37652529

Grantová podpora
P30 CA016672 NCI NIH HHS - United States
T32 CA101642 NCI NIH HHS - United States

Odkazy

PubMed 37652529
PubMed Central PMC11781375
DOI 10.1136/ijgc-2023-004711
PII: S1048-891X(24)01784-5
Knihovny.cz E-zdroje

OBJECTIVE: The etiology of inferior oncologic outcomes associated with minimally invasive surgery for early-stage cervical cancer remains unknown. Manipulation of lymph nodes with previously unrecognized low-volume disease might explain this finding. We re-analyzed lymph nodes by pathologic ultrastaging in node-negative patients who recurred in the LACC (Laparoscopic Approach to Cervical Cancer) trial. METHODS: Included patients were drawn from the LACC trial database, had negative lymph nodes on routine pathologic evaluation, and recurred to the abdomen and/or pelvis. Patients without recurrence or without available lymph node tissue were excluded. Paraffin tissue blocks and slides from all lymph nodes removed by lymphadenectomy were re-analyzed per standard ultrastaging protocol aimed at the detection of micrometastases (>0.2 mm and ≤2 mm) and isolated tumor cells (clusters up to 0.2 mm or <200 cells). RESULTS: The study included 20 patients with median age of 42 (range 30-68) years. Most patients were randomized to minimally invasive surgery (90%), had squamous cell carcinoma (65%), FIGO 2009 stage 1B1 (95%), grade 2 (60%) disease, had no adjuvant treatment (75%), and had a single site of recurrence (55%), most commonly at the vaginal cuff (45%). Only one patient had pelvic sidewall recurrence in the absence of other disease sites. The median number of lymph nodes analyzed per patient was 18.5 (range 4-32) for a total of 412 lymph nodes. A total of 621 series and 1242 slides were reviewed centrally by the ultrastaging protocol. No metastatic disease of any size was found in any lymph node. CONCLUSIONS: There were no lymph node low-volume metastases among patients with initially negative lymph nodes who recurred in the LACC trial. Therefore, it is unlikely that manipulation of lymph nodes containing clinically undetected metastases is the underlying cause of the higher local recurrence risk in the minimally invasive arm of the LACC trial.

Erratum v

PubMed

Zobrazit více v PubMed

Cancer Stat Facts: Cervical Cancer. Surveillance Research Program, National Cancer Institute. 2023.https://seer.cancer.gov/statfacts/html/cervix.html (accessed 11 May 2023).

Ramirez PT, Frumovitz M, Pareja R, et al. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. N Engl J Med 2018;379:1895–904. doi:10.1056/NEJMoa1806395 PubMed DOI

Sedlis A, Bundy BN, Rotman MZ, et al. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A gynecologic oncology group study. Gynecol Oncol 1999;73:177–83. doi:10.1006/gyno.1999.5387 PubMed DOI

Peters WA, Liu PY, Barrett RJ, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000;18:1606–13. doi:10.1200/JCO.2000.18.8.1606 PubMed DOI

Querleu D, Cibula D, Concin N, et al. Laparoscopic radical hysterectomy: a European Society of Gynaecological Oncology (ESGO) statement. Int J Gynecol Cancer 2020;30:15. doi:10.1136/ijgc-2019-000775 PubMed DOI

Koh WJ, Abu-Rustum NR, Bean S, et al. Cervical cancer, version 3.2019. JNCCN J Natl Compr Cancer Netw 2019;17:64–84. doi:10.6004/jnccn.2019.0001 PubMed DOI

Society of Gynecologic Oncology. Notice to SGO members: Emerging data on the surgical approach for radical hysterectomy in the treatment of women with cervical cancer. https://www.sgo.org/clinical-practice/guidelines/sgo-member-update-emerging-data-on-the-surgical-approach-for-radical-hysterectomy-in-the-treatment-of-women-with-cervical-cancer/le (accessed 1 Apr 2020).

FIGO statement on minimally invasive surgery in cervical cancer. Int J Gynecol Obstet 2020;149:264–264. doi:10.1002/ijgo.13141 PubMed DOI

Lewicki PJ, Basourakos SP, Qiu Y, et al. Effect of a Randomized, Controlled Trial on Surgery for Cervical Cancer. N Engl J Med 2021;384:1669–71. doi:10.1056/NEJMc2035819 PubMed DOI

Walker JL, Piedmonte MR, Spirtos NM, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 study. J Clin Oncol 2012;30:695–700. doi:10.1200/JCO.2011.38.8645 PubMed DOI PMC

Janda M, Gebski V, Davies LC, et al. Effect of total laparoscopic hysterectomy vs total abdominal hysterectomy on disease-free survival among women with stage i endometrial cancer: A randomized clinical trial. JAMA - J Am Med Assoc 2017;317:1224–33. doi:10.1001/jama.2017.2068 PubMed DOI

Kohler C, Hertel H, Herrmann J, et al. Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff - a multicenter analysis. Int J Gynecol Cancer 2019;29:845–50. doi:10.1136/ijgc-2019-000388 PubMed DOI

Fusegi A, Kanao H, Tsumura S, et al. Minimally invasive radical hysterectomy and the importance of avoiding cancer cell spillage for early-stage cervical cancer: a narrative review. J Gynecol Oncol 2023;34:e5. doi:10.3802/jgo.2023.34.e5 PubMed DOI PMC

Touhami O, Plante M. Minimally Invasive Surgery for Cervical Cancer in Light of the LACC Trial: What Have We Learned? Curr Oncol 2022;29:1093–106. doi:10.3390/curroncol29020093 PubMed DOI PMC

Colturato LF, Signorini Filho RC, Fernandes RCM, et al. Lymph node micrometastases in initial stage cervical cancer and tumoral recurrence. Int J Gynecol Obstet 2016;133:69–75. doi:10.1016/j.ijgo.2015.08.019 PubMed DOI

Guani B, Dorez M, Magaud L, et al. Impact of micrometastasis or isolated tumor cells on recurrence and survival in patients with early cervical cancer: SENTICOL Trial. Int J Gynecol Cancer 2019;29:447–52. doi:10.1136/ijgc-2018-000089 PubMed DOI

Nica A, Gien LT, Ferguson SE, et al. Does small volume metastatic lymph node disease affect long-term prognosis in early cervical cancer? Int J Gynecol Cancer 2020;30:285–90. doi:10.1136/ijgc-2019-000928 PubMed DOI

Guani B, Balaya V, Magaud L, et al. The Clinical Impact of Low-Volume Lymph Nodal Metastases in Early-Stage Cervical Cancer: The Senticol 1 and Senticol 2 Trials. Cancers (Basel) 2020;12:1061. doi:10.3390/cancers12051061 PubMed DOI PMC

Kocian R, Slama J, Fischerova D, et al. Micrometastases in Sentinel Lymph Nodes Represent a Significant Negative Prognostic Factor in Early-Stage Cervical Cancer: A Single-Institutional Retrospective Cohort Study. Cancers (Basel) 2020;12:1438. doi:10.3390/cancers12061438 PubMed DOI PMC

Buda A, Casarin J, Mueller M, et al. The impact of low-volume metastasis on disease-free survival of women with early-stage cervical cancer. J Cancer Res Clin Oncol 2021;147:1599–606. doi:10.1007/s00432-020-03435-z PubMed DOI PMC

Guani B, Mahiou K, Crestani A, et al. Clinical impact of low-volume lymph node metastases in early-stage cervical cancer: A comprehensive meta-analysis. Gynecol Oncol 2022;164:446–54. doi:10.1016/j.ygyno.2021.12.015 PubMed DOI

Dostálek L, Benešová K, Klát J, et al. 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. Gynecol Oncol 2023;168:151–6. doi:10.1016/j.ygyno.2022.11.017 PubMed DOI PMC

Cibula D, Abu-Rustum NR, Dusek L, et al. Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer. Gynecol Oncol 2012;124:496–501. doi:10.1016/j.ygyno.2011.11.037 PubMed DOI

Brandt B, Levin G, Leitao MM. Radical Hysterectomy for Cervical Cancer: the Right Surgical Approach. Curr Treat Options Oncol 2022;23:1–14. doi:10.1007/s11864-021-00919-z PubMed DOI

Chiva L, Zanagnolo V, Querleu D, et al. SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer. Int J Gynecol Cancer 2020;30:1269–77. doi:10.1136/ijgc-2020-001506 PubMed DOI

Chacon E, Manzour N, Zanagnolo V, et al. SUCCOR cone study: conization before radical hysterectomy. Int J Gynecol Cancer 2022;32:117–24. doi:10.1136/ijgc-2021-002544 PubMed DOI

Falconer H, Palsdottir K, Stalberg K, et al. Robot-assisted approach to cervical cancer (RACC): an international multi-center, open-label randomized controlled trial. Int J Gynecol Cancer 2019;29:1072–6. doi:10.1136/ijgc-2019-000558 PubMed DOI

Bixel KL, Leitao MM, Chase DM, et al. ROCC/GOG-3043: A randomized non-inferiority trial of robotic versus open radical hysterectomy for early-stage cervical cancer. J Clin Oncol 2022;40:TPS5605–TPS5605. doi:10.1200/JCO.2022.40.16_suppl.TPS5605 DOI

Lentz SE, Muderspach LI, Felix JC, et al. Identification of Micrometastases in Histologically Negative Lymph Nodes of Early-Stage Cervical Cancer Patients. Obstet Gynecol 2004;103:1204–10. doi:10.1097/01.AOG.0000125869.78251.5e PubMed DOI

Dundr P, Cibula D, Němejcová K, et al. Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer. Arch Pathol Lab Med 2020;144:1011–20. doi:10.5858/arpa.2019-0249-RA PubMed DOI

Najít záznam

Citační ukazatele

Nahrávání dat ...

Možnosti archivace

Nahrávání dat ...