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.
背景：本研究旨在明确早期宫颈癌前哨淋巴结（SLN）阳性情况下，其余非前哨淋巴结发生转移的风险因素。方法：本研究对两项关于宫颈癌前哨淋巴结活检的前瞻性多中心数据库（SENTICOL I和II）进行了辅助分析。研究对象为早期宫颈癌患者（FIGO 2018分期IA至IIA1期），经超分期检测证实双侧前哨淋巴结显影且至少存在一枚阳性前哨淋巴结。结果：SENTICOL I和II研究共纳入405例患者，其中52例患者存在双侧前哨淋巴结显影并被确诊为前哨淋巴结转移。盆腔淋巴结清扫术后，7例患者（13.5%）被诊断为非前哨淋巴结转移。非前哨淋巴结转移患者年龄更大（51.9岁 vs. 40.8岁，p=0.01），更常出现淋巴脉管间隙浸润（85.7% vs. 35.6%，p=0.03），且更易发生宫旁浸润（42.9% vs. 6.7%，p=0.003）。多变量分析显示，年龄（OR=1.16，95%置信区间[1.01-1.32]，p=0.03）和淋巴脉管间隙浸润（OR=25.97，95%置信区间[1.16-582.1]，p=0.04）与非前哨淋巴结转移独立相关。结论：在早期宫颈癌前哨淋巴结转移患者中，年龄和淋巴脉管间隙浸润似乎可预测非前哨淋巴结转移。未来需要更大规模队列研究来验证这些结果的可靠性及临床适用性。
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