2022-RA-827-ESGO Sentinel node biopsy diminishes de use of adjuvant therapy in women with early cervical cancer in the SUCCOR cohort

Introduction/Background

The aim of the study was to compare the use of adjuvant therapy in women with stage IB1 cervical cancer depending on the method used to diagnose lymphatic node invasion.

Methodology

We used data from the SUCCOR study, that collected information from 1049 women operated on stage IB1 cervical cancer between January 2013 and December 2014. Inverse probability weighting was used to adjust for surgical approach, use of uterine manipulator, lymphovascular space invasion, parametrial space invasion and conization, such that there were no significant differences between both groups. We calculated the adjusted proportion of women who received adjuvant therapy depending on the lymph node diagnosis method and compared disease free and overall survival using Cox regression.

Results

The adjusted proportion of women who received adjuvant therapy was 33.8% in the sentinel node biopsy (SNB) group and 44.7% in the lymphadenectomy group (p=0.02), although the proportion of positive nodal status in both groups was similar (14% and 10.7% respectively. p=0.30). That difference was even greater in women with negative nodal status (adjusted difference 13.7%; p=0.002) and in the analysis restricted to women with negative nodal status and positive SEDLIS criteria (adjusted difference 31.2%; p=0.01). In this last group, women who underwent a SNB had an increased risk of relapse (HR: 2.50; 95%CI 0.98–6.33) and risk of death (HR: 3.5; 95% CI 1.04–11.7) compared to those who underwent lymphadenectomy.

Conclusion

Women with the same clinical characteristics were less likely to receive adjuvant therapy if their nodal invasion was determined using SNB compared to lymphadenectomy. This difference was at the expense of women with negative nodal status but positive SEDLIS criteria. These results suggest a lack of therapeutic measures when a negative result is obtained by SNB, which may have an impact on the risk of recurrence and survival.