Clinical Controversies and Research Progress in Lymph Node Dissection for Cervical Cancer

Siqingerile

doi:10.62051/nb594z10

Authors

Siqingerile

DOI:

https://doi.org/10.62051/nb594z10

Keywords:

cervical cancer; lymph node metastasis (LNM); sentinel lymph node biopsy (SLNB); lymph node dissection (LND); tumor-draining lymph node (TDLN).

Abstract

Regional lymph node metastasis (LNM) is the main metastatic route of cervical cancer, whose rate of LNM increases in the cancer progression. LNM of cervical cancer is closely related to the cervical cancer staging, treatment method and prognosis. Lymph node dissection (LND) is an important part of standard cervical cancer staging surgeries. In recent years, Sentinel Lymph Node Biopsy (SLNB) has been used in treatments of some tumors, being considered as an alternative to Pelvic Lymph Node Dissection (PLND) in early-stage cervical cancer. However, validation regarding the feasibility of using SLNB alone as an alternative to PLND is still needed. Some scholars support PLND for patients with suspicious lymph nodes detected preoperatively due to reasons such as lower diagnostic sensitivity and specificity of preoperative imaging and potentially better prognosis for surgical staging of advanced stage of cervical cancer. However, recent basic research suggests that lymph nodes are important organs for providing tumor-specific immunity, the preservation of which facilitates immunotherapy. In this way, controversies about whether to use PLND still exist. This paper presents a brief review of the relevant research progress and discusses the new clinical definition and value of lymph nodes in the era of immunotherapy, with a view to providing new directions and ideas for the rational application of LND.

Downloads

Download data is not yet available.

References

Sung, H., et al., Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 2021. 71(3): p. 209-249.

Abu-Rustum, N.R., et al., NCCN Guidelines® Insights: Cervical Cancer, Version 1.2024. J Natl Compr Canc Netw, 2023. 21(12): p. 1224-1233.

Huang, X., et al., Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis. PLoS One, 2014. 9(10): p. e109979.

Faries, M.B., et al., Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med, 2017. 376(23): p. 2211-2222.

Giuliano, A.E., et al., Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. Jama, 2017. 318(10): p. 918-926.

Ayhan, A., et al., Para-aortic lymph node involvement revisited in the light of the revised 2018 FIGO staging system for cervical cancer. Arch Gynecol Obstet, 2019. 300(3): p. 675-682.

Cao, L., et al., Analysis of Lymph Node Metastasis and Risk Factors in 975 Patients with FIGO 2009 Stage IA-IIA Cervical Cancer. Gynecol Obstet Invest, 2023. 88(1): p. 30-36.

Cai, J., et al., Topographic distribution of lymph node metastasis in patients with stage IB1 cervical cancer: an analysis of 8314 lymph nodes. Radiat Oncol, 2021. 16(1): p. 54.

Li, W., et al., Assessment of retroperitoneal lymph node status in locally advanced cervical cancer. BMC Cancer, 2021. 21(1): p. 484.

Rob, L., et al., Current status of sentinel lymph node mapping in the management of cervical cancer. Expert Rev Anticancer Ther, 2013. 13(7): p. 861-70.

Buda, A., et al., Impact of Indocyanine Green for Sentinel Lymph Node Mapping in Early Stage Endometrial and Cervical Cancer: Comparison with Conventional Radiotracer (99m) Tc and/or Blue Dye. Ann Surg Oncol, 2016. 23(7): p. 2183-91.

Kim, C.H., et al., Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging. Int J Gynecol Cancer, 2013. 23(5): p. 964-70.

Dundr, P., et al., Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer. Arch Pathol Lab Med, 2019.

Cibula, D. and W.G. McCluggage, Sentinel lymph node (SLN) concept in cervical cancer: Current limitations and unanswered questions. Gynecol Oncol, 2019. 152(1): p. 202-207.

Benedet, J.L., et al., Carcinoma of the cervix uteri. International Journal of Gynecology and Obstetrics, 2003. 83(SUPPL. 1): p. 41-78.

Lennox, G.K. and A. Covens, Can sentinel lymph node biopsy replace pelvic lymphadenectomy for early cervical cancer? Gynecol Oncol, 2017. 144(1): p. 16-20.

Mathevet, P., et al., Sentinel lymph node biopsy and morbidity outcomes in early cervical cancer: Results of a multicentre randomised trial (SENTICOL-2). Eur J Cancer, 2021. 148: p. 307-315.

Cibula, D., et al., The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer. Radiother Oncol, 2018. 127(3): p. 404-416.

Kim, S., et al., Learning curve for sentinel lymph node mapping in gynecologic malignancies. J Surg Oncol, 2020. 121(4): p. 599-604.

Hou, H.Y., Li, B., and Wang, J.L., Interpretation of Chinese Expert Consensus on Clinical Application of Sentinel Lymph Node Biopsy for Cervical Cancer. Journal of Practical Obstetrics and Gynecology, 2022. 38(03): p. 188-191.

Xie, S., et al., The distribution pattern of pelvic lymph nodal metastases in cervical cancer. J Cancer Res Clin Oncol, 2023. 149(12): p. 9671-9677.

Zhang, H., et al., Surgical Staging of Locally Advanced Cervical Cancer: Current Status and Research Progress. Front Oncol, 2022. 12: p. 940807.

He, T., et al., PET-CT versus MRI in the diagnosis of lymph node metastasis of cervical cancer: A meta-analysis. Microsc Res Tech, 2022. 85(5): p. 1791-1798.

Aravena, A.D., et al., ACCURACY OF 18 F-FDG PET/CT FOR THE DETECTION OF PARA-AORTIC LYMPH NODE METASTASIS IN PATIENTS WITH EARLY BULKY AND LOCALLY ADVANCED UTERINE CERVICAL CARCINOMA.FIRST NATIONAL EXPERIENCE: IGCS-0046 Cervical Cancer. Int J Gynecol Cancer, 2015. 25 Suppl 1: p. 16.

Martinez, A., et al., PARa-aOrtic LymphAdenectomy in locally advanced cervical cancer (PAROLA trial): a GINECO, ENGOT, and GCIG study. Int J Gynecol Cancer, 2023. 33(2): p. 293-298.

Martinez, A., et al., How should we stage and tailor treatment strategy in locally advanced cervical cancer? Imaging versus para-aortic surgical staging. Int J Gynecol Cancer, 2020. 30(9): p. 1434-1443.

Smits, R.M., P.L. Zusterzeel, and R.L. Bekkers, Pretreatment retroperitoneal para-aortic lymph node staging in advanced cervical cancer: a review. Int J Gynecol Cancer, 2014. 24(6): p. 973-83.

Gold, M.A., et al., Surgical versus radiographic determination of para-aortic lymph node metastases before chemoradiation for locally advanced cervical carcinoma: a Gynecologic Oncology Group Study. Cancer, 2008. 112(9): p. 1954-63.

Marnitz, S., et al., Surgical versus clinical staging prior to primary chemoradiation in patients with cervical cancer FIGO stages IIB-IVA: oncologic results of a prospective randomized international multicenter (Uterus-11) intergroup study. Int J Gynecol Cancer, 2020. 30(12): p. 1855-1861.

van Kol, K.G.G., et al., The prognostic value of the presence of pelvic and/or para-aortic lymph node metastases in cervical cancer patients; the influence of the new FIGO classification (stage IIIC). Gynecol Oncol, 2023. 171: p. 9-14.

Heeren, A.M., et al., Nodal metastasis in cervical cancer occurs in clearly delineated fields of immune suppression in the pelvic lymph catchment area. Oncotarget, 2015. 6(32): p. 32484-93.

Rahim, M.K., et al., Dynamic CD8(+) T cell responses to cancer immunotherapy in human regional lymph nodes are disrupted in metastatic lymph nodes. Cell, 2023. 186(6): p. 1127-1143.e18.

Huang, Q., et al., The primordial differentiation of tumor-specific memory CD8(+) T cells as bona fide responders to PD-1/PD-L1 blockade in draining lymph nodes. Cell, 2022. 185(22): p. 4049-4066.e25.

Brown, M., et al., Lymph node blood vessels provide exit routes for metastatic tumor cell dissemination in mice. Science, 2018. 359(6382): p. 1408-1411.

van Poelgeest, M.I., et al., Potential use of lymph node-derived HPV-specific T cells for adoptive cell therapy of cervical cancer. Cancer Immunol Immunother, 2016. 65(12): p. 1451-1463.

Heeren, A.M., et al., Efficacy of PD-1 blockade in cervical cancer is related to a CD8(+)FoxP3(+)CD25(+) T-cell subset with operational effector functions despite high immune checkpoint levels. J Immunother Cancer, 2019. 7(1): p. 43.

Dammeijer, F., et al., The PD-1/PD-L1-Checkpoint Restrains T cell Immunity in Tumor-Draining Lymph Nodes. Cancer Cell, 2020. 38(5): p. 685-700.e8.

Karaman, S. and M. Detmar, Mechanisms of lymphatic metastasis. J Clin Invest, 2014. 124(3): p. 922-8.