使用具有临床病理特征的分子分类来检查明显局限于子宫的子宫内膜癌 (EC) 发生前哨淋巴结 (SLN) 转移的风险，并根据 SLN 中存在微小或宏观转移的分子亚型评估肿瘤学结果。包括任何组织学的假定子宫局限性 EC，以及成功的双侧 SLN 定位。使用已发布的算法对原发性肿瘤进行分子亚型分配。 SLN 病理学被分类为阴性、孤立的肿瘤细胞 (ITC) 或微小或宏观转移。总共包括 756 名患者； 80 名 (10%) 存在微观或宏观转移，51 名 (7%) 存在 ITC。在多变量多项 Logistic 回归中，对于拷贝数高 (CN-H)/TP53abn（OR 3.1；95% CI 1.3-7）、淋巴管间隙侵犯（[ LVSI]；OR 8.0；95% CI 4-16），以及深部肌浸润（≥50%；OR 3.33；95% CI 1.9-6.04）。 68 名宏观转移患者按亚型划分的三年 PFS 率为 38% (95% CI 10-67%) CN-低/无特定分子亚型 (CN-L/NSMP)、66% (95% CI 44- 82%）微卫星不稳定性高（MSI-H）和 23%（95% CI 10-40%）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 和 55% (95% CI 34-71%) CN-H/TP53abn (p = 0.048)。将分子亚型与子宫危险因素（LVSI 和肌浸润）相结合，进一步对接受早期 EC 手术分期的患者隐匿性 SLN 转移的风险进行分层。没有分子亚组检测到极低的 SLN 转移，支持持续的普遍 SLN 评估。患有大转移且 CN-L/NSMP 或 CN-H/TP53abn EC 的患者比患有 MSI-H EC 的患者预后更差。版权所有 © 2024 Elsevier Inc. 保留所有权利。

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.Copyright © 2024 Elsevier Inc. All rights reserved.