Publication details

Sentinel lymph node biopsy without systematic pelvic lymphadenectomy in females with early-stage cervical cancer: final outcome of the SENTIX prospective, single-arm, noninferiority, international trial

Authors	CIBULA David MARNITZ Simone JARKOVSKÝ Jiří KOCIAN Roman DUNDR Pavel KLAT Jaroslav ZAPARDIEL Ignacio ARENCIBIA Octavio LANDONI Fabio PRESL Jiri RASPAGLIESI Francesco ZIKAN Michal VAN LONKHUIJZEN Luc R C W TORNE Aureli SLAMA Jiri MINÁŘ Luboš OSTOJICH Marcela PILKA Radovan PETIZ Almerinda Ferreira PETZEL Anja BURGETOVA Andrea FISCHEROVA Daniela NEMEJCOVA Kristyna KOEHLER Christhardt
Year of publication	2025
Type	Article in Periodical
Magazine / Source	NATURE CANCER
MU Faculty or unit	Faculty of Medicine
Citation
web	https://www.nature.com/articles/s43018-025-01016-y
Doi	https://doi.org/10.1038/s43018-025-01016-y
Description	Sentinel lymph node (SLN) biopsy with ultrastaging is standard in endometrial and vulvar cancers, whereas systematic pelvic lymphadenectomy (PLND) remains recommended in cervical cancer. The SENTIX trial prospectively evaluated the safety of SLN biopsy without PLND in early-stage cervical cancer. Female patients, International Federation of Gynaecology and Obstetrics 2018 stage IA1/LVSI+ to IB2 disease, were enrolled between 2016 and 2020 across 47 sites in 18 countries. All underwent SLN biopsy followed by hysterectomy/trachelectomy. Patients with undetected, unilateral or intraoperatively metastatic SLNs were excluded from the intention-to-treat cohort. SLNs were assessed by pathological ultrastaging. Of 731 patients enrolled, 594 formed the intention-to-treat cohort. SLN metastases were identified in 82 patients (12%), 56.1% intraoperatively and 43.9% by ultrastaging. At 2 years, the recurrence rate was 6.1% (one-sided 95% CI 7.9%), confirming noninferiority to the 7% reference rate. Two-year disease-free and overall survival rates were 93.3% (95% CI 94.9-91.6) and 97.9% (95% CI 98.9-97.0), respectively. Here we show that SLN biopsy without systematic PLND did not increase the risk of recurrence in patients with early-stage cervical cancer. Pathological ultrastaging of SLNs detected about 44% of N1 cases, which would be missed by a standard lymph node assessment. Trial registration: ClinicalTrials.gov (NCT02494063).