Predictors of Non-Sentinel Lymph Node Metastasis in Patients with Positive Sentinel Lymph Node in Early-Stage Cervical Cancer: A SENTICOL GROUP Study

SIMPLE SUMMARY: For lymph node staging in the early stages of cervical cancer, sentinel lymph node (SLN) assessment, instead of full pelvic lymph node dissection, decreased the postoperative morbidity compared to full pelvic lymph node dissection. Bilateral negative SLN predicts the absence of nodal metastases, but the risk factors for lymph node involvement beyond a positive SLN remain poorly described. Through a pooled analysis of 405 patients with early cervical cancers issued from prospective multicentric cohorts SENTICOL I and II, age and lympho-vascular invasion were retained as predictors of metastasis in non-SLN patients with SLN metastasis in early-stage cervical cancer. ABSTRACT: Background: The goal of this study was to identify the risk factors for metastasis in the remaining non-sentinel lymph nodes (SLN) in the case of positive SLN in early-stage cervical cancer. Methods: An ancillary analysis of two prospective multicentric databases on SLN biopsy for cervical cancer (SENTICOL I and II) was performed. Patients with early-stage cervical cancer (FIGO 2018 IA to IIA1), with bilateral SLN detection and at least one positive SLN after ultrastaging, were included. Results: 405 patients were included in SENTICOL I and Il. Fifty-two patients had bilateral SLN detection and were found to have SLN metastasis. After pelvic lymphadenectomy, metastatic involvement of non-SLN was diagnosed in 7 patients (13.5%). Patients with metastatic non-SLN were older (51.9 vs. 40.8 years, p = 0.01), had more often lympho-vascular space invasion (LVSI) (85.7% vs. 35.6%, p = 0.03), and had more often parametrial involvement (42.9% vs. 6.7%, p = 0.003). Multivariate analysis retained age (OR = 1.16, 95% IC = [1.01–1.32], p = 0.03) and LVSI (OR = 25.97, 95% IC = [1.16–582.1], p = 0.04) as independently associated with non-SLN involvement. Conclusions: Age and LVSI seemed to be predictive of non-SLN metastasis in patients with SLN metastasis in early-stage cervical cancer. Larger cohorts are needed to confirm the results and clinical usefulness of such findings.