目的:子宫内膜癌的治疗正在推进,准确的分期对于指导治疗决策至关重要。了解不同分子亚群的前哨淋巴结(SLN)受累率至关重要。评估SLN在早期(国际妇产科联合会2009I-II)子宫内膜癌的参与,考虑分子亚型和新的欧洲妇科肿瘤学会(ESGO)风险分类。
方法:SENECA研究回顾性分析了来自16个国家66个研究中心的2139名I-II期子宫内膜癌患者的数据。在2021年1月至2022年12月期间,患者根据ESGO指南接受了SLN评估手术。对术前活检或子宫切除术标本进行分子分析。
结果:在2139名患者中,分子亚群如下:272(12.7%)p53异常(p53abn,1191(55.7%)非特异性分子谱(NSMP),581(27.2%)错配修复缺陷(MMRd),95(4.4%)POLE突变(POLE-mut)。在中检测到示踪剂扩散,至少有一面,在97.2%的病例中;在82.7%的病例中观察到双侧扩散。通过超稳定(90.7%的病例)或一步核酸扩增(198例(9.3%)),205名患者被确定为受影响的前哨淋巴结,占样本的9.6%。其中,139例(67.8%)有低体积转移(包括微转移,42.9%;和分离的肿瘤细胞,24.9%),而66(32.2%)有宏观转移。分子亚型之间观察到SLN受累的显着差异,p53abn和MMRd组的发病率最高(12.50%和12.40%,分别)与NSMP(7.80%)和POLE-mut(6.30%)相比,(p=0.004);(p53abn,OR=1.69(95%CI1.11至2.56),p=0.014;MMRd,OR=1.67(95%CI1.21至2.31),p=0.002)。ESGO风险组之间也有差异(低风险患者为2.84%,中危患者为6.62%,中高风险患者为21.63%,高危患者为22.51%;p<0.001)。
结论:我们的研究揭示了基于分子亚型的早期子宫内膜癌患者中SLN受累的显著差异。这强调了考虑分子特征以进行准确分期和最佳管理决策的重要性。
OBJECTIVE: Management of endometrial cancer is advancing, with accurate staging crucial for guiding treatment decisions. Understanding sentinel lymph node (SLN) involvement rates across molecular subgroups is essential. To evaluate SLN involvement in early-stage (International Federation of Gynecology and Obstetrics 2009 I-II) endometrial cancer, considering molecular subtypes and new European Society of Gynaecological Oncology (ESGO) risk classification.
METHODS: The SENECA study retrospectively reviewed data from 2139 women with stage I-II endometrial cancer across 66 centers in 16 countries. Patients underwent surgery with SLN assessment following ESGO guidelines between January 2021 and December 2022. Molecular analysis was performed on pre-operative biopsies or hysterectomy specimens.
RESULTS: Among the 2139 patients, the molecular subgroups were as follows: 272 (12.7%) p53 abnormal (p53abn, 1191 (55.7%) non-specific molecular profile (NSMP), 581 (27.2%) mismatch repair deficient (MMRd), 95 (4.4%) POLE mutated (POLE-mut). Tracer diffusion was detected in, at least one side, in 97.2% of the cases; with a bilateral diffusion observed in 82.7% of the cases. By ultrastaging (90.7% of the cases) or one-step nucleic acid amplification (198 (9.3%) of the cases), 205 patients were identified with affected sentinel lymph nodes, representing 9.6% of the sample. Of these, 139 (67.8%) had low-volume metastases (including micrometastases, 42.9%; and isolated tumor cells, 24.9%) while 66 (32.2%) had macrometastases. Significant differences in SLN involvement were observed between molecular subtypes, with p53abn and MMRd groups having the highest rates (12.50% and 12.40%, respectively) compared with NSMP (7.80%) and POLE-mut (6.30%), (p=0.004); (p53abn, OR=1.69 (95% CI 1.11 to 2.56), p=0.014; MMRd, OR=1.67 (95% CI 1.21 to 2.31), p=0.002). Differences were also noted among ESGO risk groups (2.84% for low-risk patients, 6.62% for intermediate-risk patients, 21.63% for high-intermediate risk patients, and 22.51% for high-risk patients; p<0.001).
CONCLUSIONS: Our study reveals significant differences in SLN involvement among patients with early-stage endometrial cancer based on molecular subtypes. This underscores the importance of considering molecular characteristics for accurate staging and optimal management decisions.