子宫内膜癌中的淋巴结转移：哨兵淋巴结映射和分子亚型时代的现代评估
Lymph node metastases in endometrial carcinoma: A modern assessment in the era of sentinel lymph node mapping and molecular subtyping
影响因子:4.10000
分区:医学2区 Top / 妇产科学1区 肿瘤学2区
发表日期:2024 Dec
作者:
Aaron M Praiss, Christian Dagher, Qin Zhou, Alexia Iasonos, Eric Rios-Doria, Nadeem R Abu-Rustum, Sarah Chiang, Amir Momeni-Boroujeni, Britta Weigelt, Lora H Ellenson, Mario M Leitao, Jennifer J Mueller
摘要
检验在明显的子宫内膜癌中前哨淋巴结（SLN）转移的风险，该子宫内膜癌（EC）使用分子分类具有临床病理学特征，并通过在SLN.Pergical contergolodical contergolodical contergolodical contigal confiend confiend confielder confielder confielder confielder confiential confielder confielder的临床病理学特征评估分子亚型的肿瘤学结果。包括SLN映射。使用已发表的算法分配原发性肿瘤分子亚型。 SLN病理学被归类为阴性，分离的肿瘤细胞（ITC）或微型或宏观焦点酶。包括756例患者； 80（10％）的微焦点或51（7％）具有ITC。 On multivariate multinomial logistic regression, risk of micro- or macro-metastases versus negative SLN was higher for ECs with copy number-high (CN-H)/TP53abn (OR 3.1; 95 % CI 1.3-7), lymphovascular space invasion ([LVSI]; OR 8.0; 95 % CI 4-16), and deep myoinvasion (≥50 %; OR 3.33; 95％CI 1.9-6.04）。 68例宏观过程患者的三年PFS率为38％（95％CI 10-67％）CN-low/NO特定分子亚型（CN-L/NSMP），66％（95％CI 44-82％）MicroSatellite Microsatelte nighite bightite Bignitional-nigh（MSI-H）（MSI-H）和95％CI（95％）（95％）（95％）（95％）（95％） CN-H/TP53ABN（P = 0.006）。三年OS率为55％（95％CI 20-80％）CN-L/NSMP，83％（95％CI 61-93％）MSI-H，55％（95％CI 34-71％）CN-H/TP53ABN（P = 0.048）（P = 0.048）。早期EC手术分期的患者的隐匿性SLN转移。没有分子亚组检测到SLN转移的极低，支持了持续的通用SLN评估。宏观过程和CN-L/NSMP或CN-H/TP53ABN EC的患者的预后比患有MSI-H EC的患者差。
Abstract
To examine the risk of sentinel lymph node (SLN) metastases in apparent uterine-confined endometrial cancer (EC) using molecular classification with clinicopathologic features and assess oncologic outcomes by molecular subtypes with micro- or macro-metastases in SLN.Patients undergoing surgical staging for presumed uterine-confined EC of any histology, with successful bilateral SLN mapping were included. Primary tumors were assigned molecular subtypes using a published algorithm. SLN pathology was categorized as negative, isolated tumor cells (ITCs), or micro- or macro-metastases.Overall, 756 patients were included; 80 (10 %) had micro- or macro-metastases and 51 (7 %) had ITCs. On multivariate multinomial logistic regression, risk of micro- or macro-metastases versus negative SLN was higher for ECs with copy number-high (CN-H)/TP53abn (OR 3.1; 95 % CI 1.3-7), lymphovascular space invasion ([LVSI]; OR 8.0; 95 % CI 4-16), and deep myoinvasion (≥50 %; OR 3.33; 95 % CI 1.9-6.04). Three-year PFS rates by subtype for 68 patients with macro-metastases were 38 % (95 % CI 10-67 %) CN-low/no specific molecular subtype (CN-L/NSMP), 66 % (95 % CI 44-82 %) microsatellite instability-high (MSI-H), and 23 % (95 % CI 10-40 %) CN-H/TP53abn (p = 0.006). Three-year OS rates were 55 % (95 % CI 20-80 %) CN-L/NSMP, 83 % (95 % CI 61-93 %) MSI-H, and 55 % (95 % CI 34-71 %) CN-H/TP53abn (p = 0.048).Integrating molecular subtype with uterine risk factors (LVSI and myoinvasion) further stratifies risk of occult SLN metastases in patients undergoing surgical staging for early-stage EC. No molecular subgroup had exceedingly low SLN metastases detected, supporting continued universal SLN assessment. Patients with macro-metastases and CN-L/NSMP or CN-H/TP53abn EC had worse outcomes than those with MSI-H EC.