Tertiary prevention strategies for micrometastatic lymph node cervical cancer: A systematic review and a prototype of an adapted model of care

Crit Rev Oncol Hematol. 2024 May:197:104329. doi: 10.1016/j.critrevonc.2024.104329. Epub 2024 Mar 26.

Abstract

Purpose: We found a need for balancing the application of clinical guidelines and tailored approaches to follow-up of cervical cancer (CC) patients in the lymph node micrometastatic (MICs) setting. This review aimed to determine the current knowledge of management of MIC-positive CC cases.

Methodology: We addressed prognostic and risk of recurrence monitoring impacts associated with MIC+ cases. The electronic databases for literature and relevant articles were analysed.

Results: Fifteen studies, (4882 patients), were included in our systematic review. While the results show that MICs significantly worsen prognosis in early CC. A tertiary prevention algorithm for low volume lymph node disease may stratify follow-up according to the burden of nodal disease and provide data that helps improve follow-up performance.

Conclusion: MICs worsen prognosis and should be managed as suggested by the algorithm. However, this algorithm must be externally validated. The clinical impact of isolated tumor cells (ITC) remains unclear.

Keywords: Algorithm; Cervical cancer; Micrometastasis; Prevention; Review; Sentinel lymph node.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Female
  • Humans
  • Lymph Nodes / pathology
  • Lymphatic Metastasis*
  • Neoplasm Micrometastasis* / pathology
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / prevention & control
  • Prognosis
  • Tertiary Prevention / methods
  • Uterine Cervical Neoplasms* / diagnosis
  • Uterine Cervical Neoplasms* / pathology
  • Uterine Cervical Neoplasms* / prevention & control