Cosma Stefano, Ferraioli Domenico, Borella Fulvio, Caretto Marta, Fuso Luca, Stura Ilaria, Bognanni Francesca, Borghi Barbara, Pace Luca, Preti Mario, Simoncini Tommaso, Chopin Nicolas, Benedetto Chiara
Gynecology and Obstetrics 1, Department of Surgical Sciences, S. Anna Hospital, City of Health and Science, University of Turin, Turin, Italy
Department of Gynecology, Léon Bérard, Comprehensive Cancer Centre, Lyon, France.
Int J Gynecol Cancer. 2024 Dec 2;34(12):1881-1887. doi: 10.1136/ijgc-2024-005769.
Missing occult para-aortic lymph node metastasis is one of the primary concerns of sentinel lymph node biopsy in endometrial cancer. Our study aimed to evaluate the relationship between intrauterine cancer site and isolated para-aortic lymph node metastasis to tailor treatment and reduce the false negative rate of the sentinel lymph node procedure.
A retrospective, multicenter, case control study was performed in four international centers. All patients with positive lymph nodes who had complete surgical staging with pelvic and para-aortic lymphadenectomy, between January 2013 and December 2023, were included. Detailed descriptions of the cancer location within the uterine cavity on the cranio-caudal plane and the myometrial wall involvement on the cranio-caudal and ventro-dorsal planes were collected, as were clinical data and cancer histological features. Patients with isolated para-aortic lymph node metastasis were allocated to group 1; patients with pelvic lymph node metastasis and those with both pelvic and para-aortic lymph node metastasis were allocated to group 2. The groups were compared according to the variables collected.
200 preoperative early stage endometrial cancer patients with postoperative International Federation of Gynecology and Obstetrics 2009/2023 stage IIIC1/IIIC2 were included in our study: 42 patients (21%) with isolated para-aortic lymph node metastasis were allocated to group 1 and the remaining patients to group 2. The two groups had comparable clinical and pathological characteristics (p>0.05): mean age was 66.5±10.3 (group 1) and 63.5±11.9 (group 2); endometrioid histotype was the predominant one for both groups (50%); most patients had myometrial infiltration >50% (80.9% and 79.7%), grade 3 (61.9% and 63.9%), and lymph vascular space invasion (78.5% and 82.2%). Cancers involving the fundal uterine cavity, the fundal myometrial wall, or the anterior myometrial wall were 3.11 (1.04-9.27), 3.03 (1.12-8.21), and 2.12 (0.77-5.80) times more likely to metastasize only to para-aortic lymph nodes compared with cancers located in other uterine sites.
In this study, the intrauterine location of the cancer determined the site of lymph node metastasis. When the tumor involved the fundus (cavity or wall) and infiltrated exclusively the anterior wall, the baseline risk of spreading only into the para-aortic area increased significantly in selected patients at risk of nodal disease.
隐匿性主动脉旁淋巴结转移的漏诊是子宫内膜癌前哨淋巴结活检的主要担忧之一。我们的研究旨在评估子宫内癌灶与孤立性主动脉旁淋巴结转移之间的关系，以制定个体化治疗方案并降低前哨淋巴结手术的假阴性率。
在四个国际中心进行了一项回顾性、多中心、病例对照研究。纳入2013年1月至2023年12月期间所有接受了盆腔和主动脉旁淋巴结清扫的完整手术分期且淋巴结阳性的患者。收集了子宫腔头-尾平面上癌灶位置以及头-尾和腹-背平面上肌层浸润情况的详细描述，以及临床数据和癌症组织学特征。孤立性主动脉旁淋巴结转移的患者被分配到第1组；盆腔淋巴结转移患者以及盆腔和主动脉旁淋巴结均转移的患者被分配到第2组。根据收集到的变量对两组进行比较。
本研究纳入了200例术前早期子宫内膜癌患者且术后国际妇产科联盟2009/2023分期为IIIC1/IIIC2期：42例（21%）孤立性主动脉旁淋巴结转移患者被分配到第1组，其余患者被分配到第2组.两组具有可比的临床和病理特征（p>0.05）：平均年龄分别为66.5±10.3（第1组）和63.5±11.9（第2组）；两组中子宫内膜样组织学类型均占主导（50%）；大多数患者肌层浸润>50%（分别为80.9%和79.7%）, 3级（分别为61.9%和63.9%），且有淋巴血管间隙浸润（分别为78.5%和82.2%）。与位于子宫其他部位的癌症相比，累及子宫底部宫腔、子宫底部肌层壁或子宫前壁肌层的癌症仅转移至主动脉旁淋巴结的可能性分别高3.11（1.04 - 9.27）倍、3.03（1.12 - 8.21）倍和2.12（0.77 - 5.80）倍。
在本研究中，癌灶在子宫内的位置决定了淋巴结转移的部位。当肿瘤累及子宫底部（宫腔或肌层壁）且仅浸润前壁时，在有淋巴结转移风险的特定患者中，仅扩散至主动脉旁区域的基线风险显著增加。
