TY - JOUR
T1 - Prognostic value of isolated tumor cells in sentinel lymph nodes in low risk endometrial cancer
T2 - results from an international multi-institutional study
AU - Cucinella, Giuseppe
AU - Schivardi, Gabriella
AU - Zhou, Xun Clare
AU - AlHilli, Mariam
AU - Wallace, Sumer
AU - Wohlmuth, Christoph
AU - Baiocchi, Glauco
AU - Tokgozoglu, Nedim
AU - Raspagliesi, Francesco
AU - Buda, Alessandro
AU - Zanagnolo, Vanna
AU - Zapardiel, Ignacio
AU - Jagasia, Nisha
AU - Giuntoli, Robert
AU - Glickman, Ariel
AU - Peiretti, Michele
AU - Lanner, Maximilian
AU - Chacon, Enrique
AU - Guilmi, Julian Di
AU - Pereira, Augusto
AU - Laas-Faron, Enora
AU - Fishman, Ami
AU - Nitschmann, Caroline C.
AU - Kurnit, Katherine
AU - Moriarty, Kristen
AU - Joehlin-Price, Amy
AU - Lees, Brittany
AU - Covens, Allan
AU - De Brot, Louise
AU - Taskiran, Cagatay
AU - Bogani, Giorgio
AU - Landoni, Fabio
AU - Grassi, Tommaso
AU - Paniga, Cristiana
AU - Multinu, Francesco
AU - De Vitis, Luigi Antonio
AU - Hernández, Alicia
AU - Mastroyannis, Spyridon
AU - Ghoniem, Khaled
AU - Chiantera, Vito
AU - Shahi, Maryam
AU - Fought, Angela J.
AU - McGree, Michaela
AU - Mariani, Andrea
AU - Glaser, Gretchen
N1 - Publisher Copyright:
© IGCS and ESGO 2024.
PY - 2024/2/5
Y1 - 2024/2/5
N2 - Objective The prognostic significance of isolated tumor cells (≤0.2 mm) in sentinel lymph nodes (SLNs) of endometrial cancer patients is still unclear. Our aim was to assess the prognostic value of isolated tumor cells in patients with low risk endometrial cancer who underwent SLN biopsy and did not receive adjuvant therapy. Outcomes were compared with node negative patients. Methods Patients with SLNs–isolated tumor cells between 2013 and 2019 were identified from 15 centers worldwide, while SLN negative patients were identified from Mayo Clinic, Rochester, between 2013 and 2018. Only low risk patients (stage IA, endometrioid histology, grade 1 or 2) who did not receive any adjuvant therapy were included. Primary outcomes were recurrence free, non-vaginal recurrence free, and overall survival, evaluated with Kaplan–Meier methods. Results 494 patients (42 isolated tumor cells and 452 node negative) were included. There were 21 (4.3%) recurrences (5 SLNs–isolated tumor cells, 16 node negative); recurrence was vaginal in six patients (1 isolated tumor cells, 5 node negative), and non-vaginal in 15 (4 isolated tumor cells, 11 node negative). Median follow-up among those without recurrence was 2.3 years (interquartile range (IQR) 1.1–3.0) and 2.6 years (IQR 0.6–4.2) in the SLN–isolated tumor cell and node negative patients, respectively. The presence of SLNs-isolated tumor cells, lymphovascular space invasion, and International Federation of Obstetrics and Gynecology (FIGO) grade 2 were significant risk factors for recurrence on univariate analysis. SLN–isolated tumor cell patients had worse recurrence free survival (p<0.01) and non-vaginal recurrence free survival (p<0.01) compared with node negative patients. Similar results were observed in the subgroup of patients without lymphovascular space invasion (n=480). There was no difference in overall survival between the two cohorts in the full sample and the subset excluding patients with lymphovascular space invasion. Conclusions Patients with SLNs–isolated tumor cells and low risk profile, without adjuvant therapy, had a significantly worse recurrence free survival compared with node negative patients with similar risk factors, after adjusting for grade and excluding patients with lymphovascular space invasion. However, the presence of SLNs–isolated tumor cells was not associated with worse overall survival.
AB - Objective The prognostic significance of isolated tumor cells (≤0.2 mm) in sentinel lymph nodes (SLNs) of endometrial cancer patients is still unclear. Our aim was to assess the prognostic value of isolated tumor cells in patients with low risk endometrial cancer who underwent SLN biopsy and did not receive adjuvant therapy. Outcomes were compared with node negative patients. Methods Patients with SLNs–isolated tumor cells between 2013 and 2019 were identified from 15 centers worldwide, while SLN negative patients were identified from Mayo Clinic, Rochester, between 2013 and 2018. Only low risk patients (stage IA, endometrioid histology, grade 1 or 2) who did not receive any adjuvant therapy were included. Primary outcomes were recurrence free, non-vaginal recurrence free, and overall survival, evaluated with Kaplan–Meier methods. Results 494 patients (42 isolated tumor cells and 452 node negative) were included. There were 21 (4.3%) recurrences (5 SLNs–isolated tumor cells, 16 node negative); recurrence was vaginal in six patients (1 isolated tumor cells, 5 node negative), and non-vaginal in 15 (4 isolated tumor cells, 11 node negative). Median follow-up among those without recurrence was 2.3 years (interquartile range (IQR) 1.1–3.0) and 2.6 years (IQR 0.6–4.2) in the SLN–isolated tumor cell and node negative patients, respectively. The presence of SLNs-isolated tumor cells, lymphovascular space invasion, and International Federation of Obstetrics and Gynecology (FIGO) grade 2 were significant risk factors for recurrence on univariate analysis. SLN–isolated tumor cell patients had worse recurrence free survival (p<0.01) and non-vaginal recurrence free survival (p<0.01) compared with node negative patients. Similar results were observed in the subgroup of patients without lymphovascular space invasion (n=480). There was no difference in overall survival between the two cohorts in the full sample and the subset excluding patients with lymphovascular space invasion. Conclusions Patients with SLNs–isolated tumor cells and low risk profile, without adjuvant therapy, had a significantly worse recurrence free survival compared with node negative patients with similar risk factors, after adjusting for grade and excluding patients with lymphovascular space invasion. However, the presence of SLNs–isolated tumor cells was not associated with worse overall survival.
UR - http://www.scopus.com/inward/record.url?scp=85179785093&partnerID=8YFLogxK
U2 - 10.1136/ijgc-2023-005032
DO - 10.1136/ijgc-2023-005032
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C2 - 38088182
AN - SCOPUS:85179785093
SN - 1048-891X
VL - 34
SP - 179
EP - 187
JO - International Journal of Gynecological Cancer
JF - International Journal of Gynecological Cancer
IS - 2
ER -