Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of OB/GYN, Weill Cornell Medical College, New York, New York, USA.
Int J Gynecol Cancer. 2024 Sep 2;34(9):1373-1381. doi: 10.1136/ijgc-2024-005522.
We assessed the prognosis and molecular subtypes of early stage endometrioid endometrial cancer with isolated tumor cells within sentinel lymph nodes (SLNs) compared with node negative disease.
Patients diagnosed with stage IA, IB, or II endometrioid endometrial cancer and primary surgical management were identified from January 1, 2007 to December 31, 2019. All SLNs underwent ultrastaging according to the institutional protocol. Patients with cytokeratin positive cells, micrometastases, and macrometastases were excluded. Clinical, pathology, and molecular subtype data were reviewed.
Overall, 1214 patients with early stage endometrioid endometrial cancer met the inclusion criteria, of whom 1089 (90%) had node negative disease and 125 (10%) had isolated tumor cells. Compared with node negative disease, the presence of isolated tumor cells had a greater association with deep myometrial invasion, lymphovascular space invasion, receipt of adjuvant therapy, and adjuvant chemotherapy with or without radiation (p<0.01). There was no significant difference in survival rates between patients with isolated tumor cells and node negative disease (3 year progression free survival rate 94% vs 91%, respectively, p=0.21; 3 year overall survival rate 98% vs 96%, respectively, p=0.45). Progression free survival did not significantly differ among patients with isolated tumor cells who received no adjuvant therapy or chemotherapy with or without radiation (p=0.31). There was no difference in the distribution of molecular subtypes between patients with isolated tumor cells (n=28) and node negative disease (n=194; p=0.26). Three year overall survival rates differed significantly when stratifying the entire cohort by molecular subtype (p=0.04).
Patients with isolated tumor cells demonstrated less favorable uterine pathologic features and received more adjuvant treatment with similar survival compared with patients with nodenegative disease. Among the available data, molecular classification did not have a significant association with the presence of isolated tumor cells, although copy number-high status was a poor prognostic indicator in early stage endometrioid endometrial cancer.
我们评估了在 SLN 中存在孤立肿瘤细胞的早期子宫内膜样腺癌患者的预后和分子亚型，与淋巴结阴性疾病进行比较。
我们从 2007 年 1 月 1 日至 2019 年 12 月 31 日，确定了诊断为 IA 期、IB 期或 II 期子宫内膜样腺癌且接受初始手术治疗的患者。所有 SLN 均根据机构方案进行超微分级。排除有细胞角蛋白阳性细胞、微转移和巨转移的患者。我们回顾了临床、病理和分子亚型数据。
共有 1214 例早期子宫内膜样腺癌患者符合纳入标准，其中 1089 例（90%）为淋巴结阴性疾病，125 例（10%）为孤立肿瘤细胞。与淋巴结阴性疾病相比，孤立肿瘤细胞的存在与更深的肌层浸润、淋巴血管间隙浸润、接受辅助治疗以及接受辅助化疗联合或不联合放疗的可能性更大（p<0.01）。在孤立肿瘤细胞与淋巴结阴性疾病患者的生存率方面没有显著差异（3 年无进展生存率分别为 94%和 91%，p=0.21；3 年总生存率分别为 98%和 96%，p=0.45）。未接受辅助治疗或接受化疗联合或不联合放疗的孤立肿瘤细胞患者之间的无进展生存率无显著差异（p=0.31）。孤立肿瘤细胞患者（n=28）和淋巴结阴性疾病患者（n=194）之间的分子亚型分布没有差异（p=0.26）。当按分子亚型对整个队列进行分层时，3 年总生存率有显著差异（p=0.04）。
与淋巴结阴性疾病患者相比，孤立肿瘤细胞患者的子宫病理特征较差，且接受了更多的辅助治疗，但生存情况相似。在现有的数据中，分子分类与孤立肿瘤细胞的存在没有显著关联，尽管拷贝数高状态是子宫内膜样腺癌早期的不良预后指标。
