Clinical Significance of Low Volume Lymph Node Metastasis in Early Stage Cervical Cancer: A Single Centre Case Series

Abstract

Background and Objectives: Lymph node involvement is uncommon in early-stage cervical cancer (7-20%), with low volume nodal disease (micrometastasis and isolated tumour cells) representing a further small subset (2-23%) of this small population.  Fewer data are available on the impact of low volume metastasis in cervical cancer. The current consensus is to treat this group of patients in the same way as for nodal macrometastasis although the prognostic significance of low volume lymph node metastasis still remains contested. The purpose of this study was to retrospectively analyze a cohort of patients who underwent primary surgery for early-stage cervical cancer and where the post operative histopathology report demonstrated low volume lymph node metastasis.  The aim was to determine the frequency of recurrence and progression free survival in groups with isolated tumor cells (<0.2 mm), micrometastasis (0.2 – 2 mm) and macrometastasis (>2 mm). Methods: Retrospective review had identified 18 patients who underwent primary surgery in single Gynaecology Cancer Centre between 2007 and 2018 for cervical cancer with subsequent histologically demonstrated lymph node metastasis. Progression free survival curves were generated for each patient group based on their histological type of lymph node metastasis. Log rank, chi squared test statistic was calculated to test for statistically significant difference in survival between groups. Results: A total of 18 patients were identified as having isolated tumor cells (n=7), micrometastasis (n=5) or macrometastasis (n=6) on post operative lymph node histopathology. Follow up data demonstrated a total of 6 recurrences overall, with the highest number in the “macrometasitasis“ group (66.7%), followed by “isolated tumor cells” group (28.6%). No recurrence was observed in the “micrometastasis” group. The difference in progression-free survival between groups was not statistically significant at alpha = 0.05 (p=0.0685). Conclusion: Further research and larger studies are required to evaluate the prognostic significance and the overall outcome in patients with isolated tumor cell lymph node metastasis in early stage cervical cancer.