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

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.