| Summary: | 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, <i>p</i> = 0.01), had more often lympho-vascular space invasion (LVSI) (85.7% vs. 35.6%, <i>p</i> = 0.03), and had more often parametrial involvement (42.9% vs. 6.7%, <i>p</i> = 0.003). Multivariate analysis retained age (OR = 1.16, 95% IC = [1.01–1.32], <i>p</i> = 0.03) and LVSI (OR = 25.97, 95% IC = [1.16–582.1], <i>p</i> = 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.
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