Todo Yukiharu, Kato Hidenori, Okamoto Kazuhira, Minobe Shinichiro, Yamashiro Katsushige, Sakuragi Noriaki
Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
Division of Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
J Gynecol Oncol. 2016 Jan;27(1):e1. doi: 10.3802/jgo.2016.27.e1. Epub 2015 Nov 23.
The aim of this study was to clarify the clinical significance of isolated tumor cells (ITCs) or micrometastasis (MM) in regional lymph nodes in patients with International Federation of Gynecology and Obstetrics (FIGO) stage I to II endometrial cancer.
In this study, a series of 63 patients with FIGO stage I to II were included, who had at least one of the following risk factors for recurrence: G3 endometrioid/serous/clear cell adenocarcinomas, deep myometrial invasion, cervical involvement, lympho-vascular space invasion, and positive peritoneal cytology. These cases were classified as intermediate-risk endometrial cancer. Ultrastaging by multiple slicing, staining with hematoxylin and eosin and cytokeratin, and microscopic examination was performed on regional lymph nodes that had been diagnosed as negative for metastases.
Among 61 patients in whom paraffin-embedded block was available, ITC/MM was identified in nine patients (14.8%). Deep myometrial invasion was significantly associated with ITC/MM (p=0.028). ITC/MM was an independent risk factor for extrapelvic recurrence (hazard ratio, 17.9; 95% confidence interval [CI], 1.4 to 232.2). The 8-year overall survival (OS) and recurrence-free survival (RFS) rates were more than 20% lower in the ITC/MM group than in the node-negative group (OS, 71.4% vs. 91.9%; RFS, 55.6% vs. 84.0%), which were statistically not significant (OS, p=0.074; RFS, p=0.066). Time to recurrence tended to be longer in the ITC/MM group than in the node-negative group (median, 49 months vs. 16.5 months; p=0.080).
It remains unclear whether ITC/MM have an adverse influence on prognosis of intermediate-risk endometrial cancer. A multicenter cooperative study is needed to clarify the clinical significance of ITC/MM.
本研究旨在阐明国际妇产科联盟（FIGO）Ⅰ至Ⅱ期子宫内膜癌患者区域淋巴结中孤立肿瘤细胞（ITCs）或微转移（MM）的临床意义。
本研究纳入了63例FIGOⅠ至Ⅱ期患者，这些患者具有以下至少一项复发风险因素：G3级子宫内膜样/浆液性/透明细胞腺癌、肌层深层浸润、宫颈受累、淋巴管间隙浸润以及腹腔细胞学检查阳性。这些病例被归类为中危子宫内膜癌。对已诊断为无转移的区域淋巴结进行多切片超分期、苏木精-伊红和细胞角蛋白染色以及显微镜检查。
在61例有石蜡包埋块的患者中，9例（14.8%）检测到ITC/MM。肌层深层浸润与ITC/MM显著相关（p = 0.028）。ITC/MM是盆腔外复发的独立危险因素（风险比，17.9；95%置信区间[CI]，1.4至232.2）。ITC/MM组的8年总生存率（OS）和无复发生存率（RFS）比淋巴结阴性组低20%以上（OS，71.4%对91.9%；RFS，55.6%对84.0%），差异无统计学意义（OS，p = 0.074；RFS，p = 0.066）。ITC/MM组的复发时间倾向于比淋巴结阴性组长（中位数，49个月对16.5个月；p = 0.080）。
ITC/MM是否对中危子宫内膜癌的预后有不良影响仍不清楚。需要进行多中心合作研究以阐明ITC/MM的临床意义。
