SUCCOR Nodes: May Sentinel Node Biopsy Determine the Need for Adjuvant Treatment?
Authors: Berasaluce Gómez Arantxa , Martín-Calvo Nerea , Boria Félix , Manzour Nabil , Chacón Enrique , Bizzarri Nicolò , Chiva Luis ,   SUCCOR Study Group, Martinez Alejandra , Quesada Alfonso , Kucukmetin Ali , Vázquez Alicia , Mandic Aljosa , Casajuana Andrea , Kavallaris Andreas , Fagotti Anna , Perrone Anna , Ferrero Annamaria , Lekuona Arantxa , Uppin Arno , Stepanyan Artem , Chiofalo Benito , Morillas Bibiana , Tauste Carmen , Andrade Claudia , Mom Constantijne , Brucker Cosima , Sarac Cosmin-Paul , Vázquez-Vicente Daniel , Cibula David , Querleu Denis , Erasun Diego , Kaidarova Dilyara , Tsolakidis Dimitrios , Haidopoulos Dimitros , Golub Dmytro , Bonci Eduard-Aexandru , Aksahin Elif , Gonçalves Elisabete , Moratalla Enrique , Karaman Erbil , Myriokefalitaki Eva , Ghezzi Fabio , Narducci Fabrice , Roldan Fernando , Raspagliesi Francesco , Goffin Frédéric , Grandjean Frederic , Guyon Frédéric , Demirkiran Fuat , Fiol Gabriel , Chakalova Galina , Mancebo Gemma , Vorgias George , Gebauer Gerhard , Meili Gesine , Hernandez-Cortes Gines , Bogani Giorgio , Cordeiro Gloria , Vujić Goran , Mendinhos Gustavo , Trum Hans , Bonsang-Kitzis Hélène , Haller Herman , Vergote Ignace , Zapardiel Ignacio , Aluloski Igor , Berlev Igor , Pete Imre , Kalogiannidis Ioannis , Kotsopoulos Ioannis , Yezhova Iryna , Díez Javier , Feron Jean G. , Scharf Jens-Peter , Beltman Jogchum , Haesen Jolien , Ponce Jordi , Cea Jorge , Mínguez Jose Ángel , García José , Arévalo-Serrano Juan , Gilabert Juan , Alcazar Juan Luis , Kukk Kersti , Galaal Khadra , Cárdenas Laura , Pirtea Laurentiu , Mereu Liliana , Anchora Luigi Pedone , Dostalek Lukas , Klasa Lukasz , PakižImre Maja , Undurraga Manuela , Jedryka Marcin , Bernardino Margarida , Alonso-Espias Maria , Martín-Salamanca María Belén , Cuadra Maria , Tavares Mariana , Malzoni Mario , Fehr Mathias , Luyckx Mathieu , Lanner Maximilian , Leht Meelis , Meydanli Mehmet , Mallmann Michael , Căpîlna Mihai , Redecha Mikulás , Mitrovic Milena , Maenpaa Minna M. , Guijarro Miriam , Abdalla Nabil , Gomes Nana , Povolotskaya Natalia , Badzakov Nikola , Arencibia Octavio , Akbayir Özgür , Cavalle Pere , Zusterzeel Petra , Rolland Philip , Coronado Pluvio , Bharathan Rasiah , Saaron Reeli , Sousa Rita , Fruscio Robert , Jach Robert , Poka Robert , Barrachina Rosa , Domingo Santiago , Morales Sara , Akgöl Sedat , Fernandez-Gonzalez Sergi , Aliyev Shamistan , Herrero Sofía , Fidalgo Soledad , Prader Sonia , Smrkolj Špela , Petousis Stamatios , Kovachev Stefan , Turan Taner , Toptas Tayfun , Castellanos Teresa , da Costa Teresa Diniz , Marina Tiermes , Zanagnolo Vanna , Martin Victor , Gonzalez Virginia , Študent Vladimír , Sukhin Vladyslav 
Published: May 2023

Abstract
Background
The SUCCOR cohort was developed to analyse the overall and disease-free survival at 5 years in women with FIGO 2009 stage IB1 cervical cancer. The aim of this study was to compare the use of adjuvant therapy in these women, depending on the method used to diagnose lymphatic node metastasis.

Patients and Methods
We used data from the SUCCOR cohort, which collected information from 1049 women with FIGO 2009 stage IB1 cervical cancer who were operated on between January 2013 and December 2014 in Europe. We calculated the adjusted proportion of women who received adjuvant therapy depending on the lymph node diagnosis method and compared disease free and overall survival using Cox proportional-hazards regression models. Inverse probability weighting was used to adjust for baseline potential confounders.

Results
The adjusted proportion of women who received adjuvant therapy was 33.8% in the sentinel node biopsy + lymphadenectomy (SNB+LA) group and 44.7% in the LA group (p = 0.02), although the proportion of positive nodal status was similar (p = 0.30). That difference was greater in women with negative nodal status and positive Sedlis criteria (difference 31.2%, p = 0.01). Here, those who underwent a SNB+LA had an increased risk of relapse [hazard ratio (HR) 2.49, 95% confidence interval (CI) 0.98–6.33, p = 0.056] and risk of death (HR 3.49, 95% CI 1.04–11.7, p = 0.042) compared with those who underwent LA.

Conclusions
Women in this study were less likely to receive adjuvant therapy if their nodal invasion was determined using SNB+LA compared with LA. These results suggest a lack of therapeutic measures available when a negative result is obtained by SNB+LA, which may have an impact on the risk of recurrence and survival.