Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
Gynecol Oncol. 2022 May;165(2):264-269. doi: 10.1016/j.ygyno.2022.02.015. Epub 2022 Feb 26.
To examine the characteristics of isolated tumor cells (ITCs) in regional lymph nodes of early-stage endometrial cancer.
This is a retrospective cohort study examining the National Cancer Institute's Surveillance, Epidemiology, and End Result Program. The study population was 6472 women with non-metastatic, node-negative T1 endometrial cancer who underwent primary hysterectomy and surgical nodal evaluation. Multivariable binary logistic regression model was used to identify the independent characteristics for ITCs. Postoperative therapy according to ITCs status was also assessed with propensity score weighting.
ITCs were seen in 111 (1.7%) cases. In a multivariable analysis, ITCs were largely associated with tumor factors including deep myometrial invasion (T1b versus T1a, 4.0% versus 1.0%, adjusted-odds ratio [aOR] 3.42, P < 0.001) and larger tumor size (>4 versus ≤4 cm, 3.0% versus 1.6%, aOR 1.55, P = 0.037). Moreover, women undergoing sentinel lymph node (SLN) biopsy had a higher likelihood of identifying ITCs compared to those undergoing lymphadenectomy (LND): 2.7% for SLN alone, 3.7% for SLN/LND, and 1.2% for LND alone (aOR ranged 2.60-2.99, P < 0.001). Women who had ITCs identified were more likely to receive postoperative therapy (81.8% versus 31.7%, P < 0.001), including external beam radiotherapy (EBT) alone (25.1% versus 3.2%) and chemotherapy/EBT (16.3% versus 1.9%). Similar associations were observed in the low-risk group (stage IA, grade 1-2 endometrioid, 78.4% versus 9.2%, P < 0.001), including EBT alone (35.3% versus 0.6%).
This study suggests that a SLN protocol can identify more ITCs in the regional lymph nodes of early endometrial cancer. Deep myometrial invasion and large tumor size were associated with increased risk of ITCs. Postoperative therapy is offered more frequently in the setting of ITCs with variable treatment patterns, warranting further outcome studies and practice guidelines.
研究早期子宫内膜癌区域淋巴结中孤立肿瘤细胞（ITCs）的特征。
这是一项回顾性队列研究，对美国国家癌症研究所的监测、流行病学和最终结果计划进行了调查。研究人群为 6472 名非转移性、淋巴结阴性 T1 期子宫内膜癌患者，这些患者接受了根治性子宫切除术和手术淋巴结评估。采用多变量二项逻辑回归模型确定 ITCs 的独立特征。还使用倾向评分加权法评估了根据 ITCs 状态进行的术后治疗。
111 例（1.7%）病例中可见 ITCs。多变量分析中，ITCs 主要与肿瘤因素相关，包括深肌层浸润（T1b 与 T1a，4.0%与 1.0%，校正优势比[aOR]3.42，P<0.001）和更大的肿瘤大小（>4cm 与≤4cm，3.0%与 1.6%，aOR 1.55，P=0.037）。此外，与接受淋巴结清扫术（LND）的患者相比，接受前哨淋巴结（SLN）活检的患者更有可能发现 ITCs：SLN 单独为 2.7%，SLN/LND 为 3.7%，LND 单独为 1.2%（aOR 范围为 2.60-2.99，P<0.001）。发现 ITCs 的患者更有可能接受术后治疗（81.8%与 31.7%，P<0.001），包括外照射放疗（EBT）单独（25.1%与 3.2%）和化疗/EBT（16.3%与 1.9%）。在低危组（IA 期，G1-2 子宫内膜样，78.4%与 9.2%，P<0.001）中也观察到了类似的关联，包括 EBT 单独（35.3%与 0.6%）。
本研究表明，SLN 方案可在早期子宫内膜癌的区域淋巴结中识别更多的 ITCs。深肌层浸润和大肿瘤大小与 ITCs 风险增加相关。在 ITCs 存在的情况下，更频繁地提供术后治疗，其治疗方式具有变异性，需要进一步进行结局研究和制定实践指南。
