MILACC 研究：LACC 试验中未检测到的淋巴结微转移是否会影响复发率？
MILACC study: could undetected lymph node micrometastases have impacted recurrence rate in the LACC trial?
机构信息
Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA.
出版信息
Int J Gynecol Cancer. 2023 Nov 6;33(11):1684-1689. doi: 10.1136/ijgc-2023-004711.
OBJECTIVE
The etiology of inferior oncologic outcomes associated with minimally invasive surgery for early-stage cervical cancer remains unknown. Manipulation of lymph nodes with previously unrecognized low-volume disease might explain this finding. We re-analyzed lymph nodes by pathologic ultrastaging in node-negative patients who recurred in the LACC (Laparoscopic Approach to Cervical Cancer) trial.
METHODS
Included patients were drawn from the LACC trial database, had negative lymph nodes on routine pathologic evaluation, and recurred to the abdomen and/or pelvis. Patients without recurrence or without available lymph node tissue were excluded. Paraffin tissue blocks and slides from all lymph nodes removed by lymphadenectomy were re-analyzed per standard ultrastaging protocol aimed at the detection of micrometastases (>0.2 mm and ≤2 mm) and isolated tumor cells (clusters up to 0.2 mm or <200 cells).
RESULTS
The study included 20 patients with median age of 42 (range 30-68) years. Most patients were randomized to minimally invasive surgery (90%), had squamous cell carcinoma (65%), FIGO 2009 stage 1B1 (95%), grade 2 (60%) disease, had no adjuvant treatment (75%), and had a single site of recurrence (55%), most commonly at the vaginal cuff (45%). Only one patient had pelvic sidewall recurrence in the absence of other disease sites. The median number of lymph nodes analyzed per patient was 18.5 (range 4-32) for a total of 412 lymph nodes. A total of 621 series and 1242 slides were reviewed centrally by the ultrastaging protocol. No metastatic disease of any size was found in any lymph node.
CONCLUSIONS
There were no lymph node low-volume metastases among patients with initially negative lymph nodes who recurred in the LACC trial. Therefore, it is unlikely that manipulation of lymph nodes containing clinically undetected metastases is the underlying cause of the higher local recurrence risk in the minimally invasive arm of the LACC trial.
目的
与早期宫颈癌的微创手术相关的肿瘤学结局较差的病因尚不清楚。淋巴结中以前未被认识到的低体积疾病的操作可能解释了这一发现。我们通过病理超分期重新分析了 LACC（腹腔镜宫颈癌）试验中淋巴结阴性但复发的患者的淋巴结。
方法
从 LACC 试验数据库中纳入患者，常规病理评估淋巴结阴性，且复发至腹部和/或骨盆。排除无复发或无淋巴结组织可供使用的患者。根据旨在检测微转移（>0.2mm 和 ≤2mm）和孤立肿瘤细胞（最大 0.2mm 或 <200 个细胞的簇）的标准超分期方案，对所有淋巴结切除术中切除的石蜡组织块和切片进行重新分析。
结果
该研究纳入了 20 名中位年龄为 42 岁（范围 30-68 岁）的患者。大多数患者接受了微创手术（90%），组织学类型为鳞状细胞癌（65%），FIGO 2009 分期 1B1（95%），组织学分级为 2 级（60%），无辅助治疗（75%），且仅单一部位复发（55%），最常见的是阴道残端（45%）。仅 1 例患者在无其他疾病部位的情况下出现骨盆侧壁复发。每位患者平均分析的淋巴结数为 18.5（范围 4-32），共分析了 412 个淋巴结。总共对 621 个系列和 1242 个载玻片进行了中央超分期方案的复查。在任何淋巴结中均未发现任何大小的转移性疾病。
结论
在 LACC 试验中复发的最初淋巴结阴性患者中，没有淋巴结低体积转移。因此，微创手术组中局部复发风险较高不太可能是由于操作含有临床无法检测到的转移的淋巴结所致。
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