Plante Marie, Stanleigh Jonathan, Renaud Marie-Claude, Sebastianelli Alexandra, Grondin Katherine, Grégoire Jean
Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada.
Gynecologic Oncology Division, Sharei-Zedek Medical Center, Hebrew University of Jerusalem, Israel.
Gynecol Oncol. 2017 Aug;146(2):240-246. doi: 10.1016/j.ygyno.2017.05.024. Epub 2017 May 31.
To evaluate the outcome and the role of adjuvant treatment in the management of patients with endometrial cancer and isolated tumor cells (ITCs) identified by SLN mapping.
This single center study identified all patients undergoing hysterectomy, salpingo-oophorectomy, lymphadenectomy and SLN mapping for endometrial cancer between November 2010 and December 2015. Data was prospectively collected. Progression-free survival was analyzed according to the Kaplan-Meier method and compared using the log-rank test.
A total of 519 patients were included. Overall, 85 patients (16.4%) were found to have SLN metastases of which 43 (51%) were macrometastasis, 11 (13%) micrometastasis (MM) and 31 (36%) ITC. Eleven (35%) of patients with ITCs received adjuvant chemotherapy±whole pelvic radiation therapy (WPRT), 10 (32%) received WPRT, and 10 (32%) received either no adjuvant treatment or vault brachytherapy (VBT) only. ITC patients received significantly less chemotherapy (p=0.0001) and WPRT (p=0.007) compared to patients with macrometastasis. Of note, ITC were not considered node positive in our study. With a median follow-up of 29months (range: 0-67), the progression free survival (PFS) at 3-years for the ITC patients was 95.5%, similar to node negative (87.6%) and micrometastasis patients (85.5%), but statistically better than patients with macrometastasis (58.5%) (p=0.0012). Only 1/31 patient with ITC recurred (IB, 7cm carcinosarcoma) despite adjuvant treatments. None of the ITC patients with endometrioid histology recurred (0/28) and none of the ITC patients who did not receive adjuvant treatment or VBT recurred (0/10).
Patients with endometrial cancer found to have SLN ITCs have an excellent outcome. The use of adjuvant treatment should be tailored to uterine factors and histology and not solely based on the presence of ITCs. Patients with ITCs and otherwise low-risk uterine disease probably derive little benefit from receiving additional treatments. More studies are needed to confirm our results.
评估前哨淋巴结（SLN）定位识别出的孤立肿瘤细胞（ITC）在子宫内膜癌患者管理中的治疗结局及辅助治疗的作用。
这项单中心研究纳入了2010年11月至2015年12月期间所有因子宫内膜癌接受子宫切除术、输卵管卵巢切除术、淋巴结清扫术及SLN定位的患者。数据前瞻性收集。采用Kaplan-Meier法分析无进展生存期，并使用对数秩检验进行比较。
共纳入519例患者。总体而言，85例（16.4%）患者存在SLN转移，其中43例（51%）为大转移，11例（13%）为微转移（MM），31例（36%）为ITC。11例（35%）ITC患者接受了辅助化疗±全盆腔放疗（WPRT），10例（32%）接受了WPRT，10例（32%）未接受辅助治疗或仅接受了阴道近距离放疗（VBT）。与大转移患者相比，ITC患者接受的化疗（p=0.0001）和WPRT（p=0.007）显著更少。值得注意的是，在我们的研究中ITC不被视为淋巴结阳性。中位随访29个月（范围：0 - 67个月），ITC患者3年无进展生存期（PFS）为95.5%，与淋巴结阴性患者（87.6%）和微转移患者（85.5%）相似，但在统计学上优于大转移患者（58.5%）（p=0.0012）。尽管接受了辅助治疗，31例ITC患者中仅1例复发（IB期，7cm癌肉瘤）。子宫内膜样组织学的ITC患者无一复发（0/28），未接受辅助治疗或VBT的ITC患者也无一复发（0/10）。
发现存在SLN ITC的子宫内膜癌患者预后良好。辅助治疗的使用应根据子宫因素和组织学进行调整，而不能仅基于ITC的存在。ITC且子宫疾病其他方面为低风险的患者可能从额外治疗中获益甚微。需要更多研究来证实我们的结果。
