Kenkel Camryn, Lee Sarah S, Mehta Naaman, Nawlo Jude, Jimenez Edward, Boyd Leslie R
New York University Grossman School of Medicine, New York, NY, United States.
Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, NYU Langone Health, New York, NY, United States.
Gynecol Oncol Rep. 2025 Mar 1;58:101713. doi: 10.1016/j.gore.2025.101713. eCollection 2025 Apr.
Sentinel lymph node biopsy (SLNB) for endometrial cancer staging may identify isolated tumor cells (ITCs). Although guidelines do not classify nodes with ITCs as positive, earlier papers reported that a significant proportion of gynecologic oncologists treat ITCs as they would positive nodes. The objective of this study was to examine practice patterns and determine if the presence of ITCs in endometrial cancer affects adjuvant treatment decision-making.
This was a retrospective series of patients with endometrial adenocarcinoma stages I to IIIB who underwent surgical staging with SNLB from July 2016 to January 2022 at three hospitals. The primary outcome of interest was the receipt of adjuvant treatment. Chi-square, Mann-Whitney test, and logistic regression were used with significance set at p < 0.05.
Of seven hundred thirty-four patients included, ITCs were identified in 41 patients (5.6 %). Deep myometrial invasion (61.0 % vs 20.5 %, p < 0.001) and lymphovascular invasion (58.4 % vs 17.7 %, p < 0.001) were more common in patients with ITCs than in those with negative lymph nodes. Patients with ITCs were more likely to receive adjuvant treatment (30 of 41, 73.2 % vs 289 of 693, 41.7 %, p < 0.001). When controlling for age, stage, histology, grade, and lymphovascular space invasion, ITCs were not associated with an increased likelihood of adjuvant therapy receipt.
Although patients with ITCs were more likely to receive adjuvant treatment, this was accounted for by other clinical and histological factors. Clinicians were likely to make decisions based on established risk factors, and more data are needed on the role of ITCs in the landscape of molecularly based decision making.
前哨淋巴结活检（SLNB）用于子宫内膜癌分期时可能会发现孤立肿瘤细胞（ITC）。尽管指南未将有ITC的淋巴结归类为阳性，但早期文献报道，相当一部分妇科肿瘤学家会将ITC视为阳性淋巴结进行处理。本研究的目的是调查实际操作模式，并确定子宫内膜癌中ITC的存在是否会影响辅助治疗的决策。
这是一项回顾性研究，纳入了2016年7月至2022年1月在三家医院接受SLNB手术分期的I至IIIB期子宫内膜腺癌患者。主要关注的结局是辅助治疗的接受情况。采用卡方检验、曼-惠特尼检验和逻辑回归分析，显著性水平设定为p < 0.05。
在纳入的734例患者中，41例（5.6%）发现有ITC。有ITC的患者比淋巴结阴性的患者更常见肌层深层浸润（61.0%对20.5%，p < 0.001）和脉管浸润（58.4%对17.7%，p < 0.001）。有ITC的患者更有可能接受辅助治疗（41例中的30例，73.2%对693例中的289例，41.7%，p < 0.001）。在控制年龄、分期、组织学类型、分级和脉管间隙浸润后，ITC与接受辅助治疗的可能性增加无关。
尽管有ITC的患者更有可能接受辅助治疗，但这是由其他临床和组织学因素导致的。临床医生可能基于既定的风险因素做出决策，关于ITC在基于分子的决策中的作用还需要更多数据。
