Temporal trends of sentinel lymph node biopsy without lymphadenectomy at cervical cancer surgery

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2025-04-19 DOI:10.1016/j.ygyno.2025.04.519

Emmeline L. Friedman , X. Mona Guo , Katelyn B. Furey , Alice J. Lee , Shinya Matsuzaki , Mamoru Kakuda , Mariya Kobayashi , Michiko Kodama , Hiroyuki Kanao , Maximilian Klar , Lynda D. Roman , Jason D. Wright , Koji Matsuo

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Abstract

Objective

To assess temporal trends of sentinel lymph node biopsy alone without additional lymphadenectomy at surgery for cervical cancer in the United States.

Methods

This retrospective cohort study queried the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Study population was 13,498 patients with American Joint Commission on Cancer T1 classification cervical cancer who underwent anti-cancer surgery either with hysterectomy, trachelectomy, or cervical excision and additional surgical nodal evaluation from 2004 to 2021. Temporal trends were assessed with linear segment regression model. In exploratory analysis, survival was assessed with multivariable Cox proportional hazard regression model.

Results

Utilization rate of sentinel lymph node biopsy with or without lymphadenectomy increased from 0.2% to 15.1% in 2004–2018 (P-trend<0.001), followed by stabilization after 2018 (15.1% to 17.3%, P-trend=0.752). Utilization rate of sentinel lymph node biopsy alone without additional lymphadenectomy exceeded the rate of concurrent sentinel lymph node biopsy together with lymphadenectomy in 2018 (8.8% versus 6.3%). Following this surgery-shift in 2018, sentinel lymph node biopsy alone without additional lymphadenectomy continued to increase from 8.8% to 11.3% between 2018 and 2021 (P-trend<0.001). In 2021, nearly two thirds of sentinel lymph node evaluation were performed by sentinel lymph node biopsy alone without additional lymphadenectomy (65.2%). Sentinel lymph node biopsy alone and sentinel lymph node biopsy with additional lymphadenectomy had comparable cervical cancer-specific survival (5-year rates 96.5% versus 95.7%, P=0.828) and overall survival (95.3 % versus 94.6 %, P =0.893).

Conclusion

This population-based assessment suggests that the majority of sentinel lymph node assessments for cervical cancer after the late-2010s were performed without additional lymphadenectomy.

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宫颈癌手术中前哨淋巴结活检无淋巴结切除术的时间趋势

方法这项回顾性队列研究查询了美国国家癌症研究所的监测、流行病学和最终结果计划。研究对象为美国癌症联合委员会 T1 级宫颈癌患者，共 13498 人，他们在 2004 年至 2021 年期间接受了抗癌手术，包括子宫切除术、气管切除术或宫颈切除术，并进行了额外的手术结节评估。采用线性分段回归模型评估了时间趋势。在探索性分析中，采用多变量 Cox 比例危险回归模型评估生存率。结果 2004-2018 年，前哨淋巴结活检（无论是否进行淋巴结切除术）的使用率从 0.2% 上升至 15.1%（P-trend<0.001），2018 年后趋于稳定（15.1% 至 17.3%，P-trend=0.752）。2018年，单独进行前哨淋巴结活检而不进行额外淋巴结切除术的使用率超过了同时进行前哨淋巴结活检和淋巴结切除术的使用率（8.8%对6.3%）。继 2018 年的这一手术转变之后，2018 年至 2021 年期间，单独前哨淋巴结活检而不进行额外淋巴结切除术的比例继续从 8.8% 上升至 11.3%（P-trend<0.001）。2021 年，近三分之二的前哨淋巴结评估是通过前哨淋巴结活检单独进行的，无需额外的淋巴腺切除术（65.2%）。单纯前哨淋巴结活检和前哨淋巴结活检加额外淋巴结切除术的宫颈癌特异性生存率（5 年率 96.5% 对 95.7%，P=0.828）和总生存率（95.3% 对 94.6%，P=0.893）相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy