Ⅰ期/Ⅱ期子宫内膜样癌中前哨淋巴结（SLN）孤立肿瘤细胞（ITCs）：治疗还是不治疗？
Sentinel lymph node (SLN) isolated tumor cells (ITCs) in otherwise stage I/II endometrioid endometrial cancer: To treat or not to treat?
机构信息
The Ohio State University, James Cancer Hospital, Columbus, OH, USA.
The Ohio State University College of Public Health, Columbus, OH, USA.
出版信息
Gynecol Oncol. 2021 May;161(2):347-352. doi: 10.1016/j.ygyno.2021.02.017. Epub 2021 Mar 5.
OBJECTIVES
To assess associations between treatment and recurrence-free survival (RFS) among patients with isolated tumor cells (ITCs) in sentinel lymph nodes (SLN) and otherwise stage I/II endometrioid endometrial cancer (EC).
METHODS
A multi-institutional retrospective study of patients with SLN ITCs (<200 cells and < 0.2 mm) was performed. Only patients with otherwise stage I/II EC, endometrioid histology, and no evidence of micro-or macrometastases were included. Univariate and multivariable Cox proportional hazard models were used to evaluate associations between treatment, tumor characteristics, and RFS.
RESULTS
175 patients were included. Median follow up time was 31 months. 39% stage IB and 12% stage II disease. 76 (43%) received no adjuvant therapy or vaginal brachytherapy only (NAT/VBT), 21 (12%) had external beam radiation (EBRT), and 78 (45%) received chemotherapy +/- radiation. Patients who received chemotherapy more often had tumors with deep myoinvasion, lymphovascular space invasion (LVSI), and higher grade. Nine (5.1%) patients recurred; 5 distant, 3 retroperitoneal, and 1 vaginal. Extra-vaginal recurrences were similar in patients with or without chemotherapy (5.2% vs 3.8%, p = 0.68). After controlling for stage, LVSI and grade, chemotherapy and EBRT were not associated with RFS (HR = 0.63, 95%CI 0.11-3.52, and HR = 0.90, 95%CI 0.22-3.61, respectively). Type of lymph node dissection and ITC detection method were not associated with RFS.
CONCLUSIONS
Risk of retroperitoneal and/or distant recurrence is low (4.6%) for patients with stage I/II endometrioid EC and ITCs in SLNs regardless of treatment. Our preliminary data suggests that adjuvant therapy may not be significantly associated with RFS. However, longer follow-up time and a larger sample size are needed before definitive recommendations regarding adjuvant therapy for patients with EC and only ITCs in SLN can be made.
目的
评估在 SLN 中存在孤立肿瘤细胞（ITC）的患者与其他 I 期/II 期子宫内膜样子宫内膜癌（EC）患者之间，治疗与无复发生存（RFS）之间的关联。
方法
对 SLN ITCs（<200 个细胞和<0.2mm）患者进行了多机构回顾性研究。仅纳入其他 I 期/II 期 EC、子宫内膜样组织学和无微/宏观转移证据的患者。采用单变量和多变量 Cox 比例风险模型评估治疗、肿瘤特征与 RFS 之间的关系。
结果
纳入 175 例患者。中位随访时间为 31 个月。39%为 IB 期，12%为 II 期疾病。76 例（43%）未接受辅助治疗或仅接受阴道近距离放疗（NAT/VBT），21 例（12%）接受外照射放疗（EBRT），78 例（45%）接受化疗+/-放疗。接受化疗的患者肿瘤常有更深的肌层浸润、脉管侵犯（LVSI）和更高的分级。9 例（5.1%）患者复发；5 例远处复发，3 例腹膜后复发，1 例阴道复发。阴道外复发在有或无化疗的患者中相似（5.2%比 3.8%，p=0.68）。在控制了分期、LVSI 和分级后，化疗和 EBRT 与 RFS 无关（HR=0.63，95%CI 0.11-3.52 和 HR=0.90，95%CI 0.22-3.61）。淋巴结清扫术类型和 ITC 检测方法与 RFS 无关。
结论
对于 SLN 中存在 ITCs 的 I 期/II 期子宫内膜样 EC 患者，无论治疗与否，腹膜后和/或远处复发的风险均较低（4.6%）。我们的初步数据表明，辅助治疗可能与 RFS 无显著相关性。然而，在对 SLN 中仅存在 ITCs 的 EC 患者的辅助治疗做出明确建议之前，还需要更长的随访时间和更大的样本量。
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