Siegenthaler Franziska, Imboden Sara, Büchi Carol, Christe Lucine, Solass Wiebke, Saner Flurina, Rauh Claudia, Hofer Seline, Schlatter Bettina, Wampfler Julian, Mohr Stefan, Papadia Andrea, Anokhina Maria, Göring Wolfgang, Rau Tilman T, Mueller Michael D
Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland.
Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland.
Gynecol Oncol. 2025 Feb;193:12-19. doi: 10.1016/j.ygyno.2024.12.014. Epub 2025 Jan 6.
Treatment approaches for endometrial cancer became more personalized in the last decade, mainly due to two key advancements - sentinel lymph node (SLN) mapping and molecular classification. However, their prognostic interaction remains relatively unexplored.
This retrospective cohort study included patients with endometrial cancer, who underwent surgical treatment including SLN mapping at the Bern University Hospital, Switzerland. Ultrastaging of the SLNs and a molecular analysis on the primary tumor was performed.
The study cohort included 206 patients, of which 197 tumor samples underwent molecular classification. 11.2 % were classified as POLEmut, 25.9 % as MMRd, 46.2 % as NSMP, and 16.8 % as p53abn. Overall, 834 SLN were removed. SLN macrometastasis were most prevalent in patients with p53abn tumors (24.2 %), followed by MMRd (13.7 %), NSMP (5.5 %), and POLEmut (0 %) tumors (p = .006). Mean follow-up time was 70.9 months. SLN macrometastasis was significantly associated with a higher risk of recurrence in the entire study cohort (p > .001) and the NSMP subgroup (p > .001). In the MMRd subgroup, SLN macrometastasis remained a significant predictor of recurrence (p = .030) and disease-specific death (p = .047) in multivariate Cox regression analysis. For patients with p53abn endometrial cancer, there was no association between SLN macrometastasis and risk of recurrence (p = .618) or disease specific death (p = .798).
SLN macrometastasis is an independent predictor of recurrence and disease-specific death in patients with MMRd endometrial cancer. In the subgroup of p53abn endometrial cancers, SLN macrometastasis did not have an added impact on oncological outcome.
在过去十年中，子宫内膜癌的治疗方法变得更加个性化，主要得益于两项关键进展——前哨淋巴结（SLN）定位和分子分类。然而，它们的预后相互作用仍相对未被探索。
这项回顾性队列研究纳入了在瑞士伯尔尼大学医院接受包括SLN定位在内的手术治疗的子宫内膜癌患者。对SLN进行超分期，并对原发性肿瘤进行分子分析。
研究队列包括206例患者，其中197个肿瘤样本进行了分子分类。11.2%被归类为POLE突变型，25.9%为错配修复缺陷型（MMRd），46.2%为非特异性分子谱（NSMP），16.8%为p53异常型。总体而言，共切除834个SLN。SLN大转移在p53异常型肿瘤患者中最为常见（24.2%），其次是MMRd（13.7%）、NSMP（5.5%）和POLE突变型（0%）肿瘤（p = 0.006）。平均随访时间为70.9个月。在整个研究队列（p > 0.001）和NSMP亚组（p > 0.001）中，SLN大转移与较高的复发风险显著相关。在MMRd亚组中，在多变量Cox回归分析中，SLN大转移仍然是复发（p = 0.030）和疾病特异性死亡（p = 0.047）的显著预测因素。对于p53异常型子宫内膜癌患者，SLN大转移与复发风险（p = 0.618）或疾病特异性死亡（p = 0.798）之间没有关联。
SLN大转移是MMRd子宫内膜癌患者复发和疾病特异性死亡的独立预测因素。在p53异常型子宫内膜癌亚组中，SLN大转移对肿瘤学结局没有额外影响。
