伴有孤立肿瘤细胞淋巴结转移的中高危险子宫内膜癌的复发和生存

IF 1.2 Q3 OBSTETRICS & GYNECOLOGY

Gynecologic Oncology Reports Pub Date : 2025-02-01 DOI:10.1016/j.gore.2025.101684

Ahmad Awada, Fernando O. Recio, Theresa M. Kuhn, Sarfraz Ahmad, Jianbin Zhu, Nathalie D. McKenzie, James E. Kendrick, Robert W. Holloway

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引用次数: 0

摘要

目的比较化疗/放疗（CRT）与体外射束放疗（EBRT）/阴道近距离放疗（VBT）治疗早期高危（HIR）子宫内膜癌（EC）和孤立肿瘤细胞（ITC）淋巴结转移患者的临床疗效。方法我们从本机构的数据库中回顾性地识别了所有接受CRT或EBRT治疗的早期HIR子宫内膜癌和ITC患者（2015年1月至2023年12月）。根据 NCCN 指南，所有患者均接受了前哨淋巴结 (SLN) 评估。无进展生存期（PFS）和癌症特异性生存期（CSS）采用 Kaplan-Meier 法进行分析。我们在 HIR-ITC 队列中使用了 GOG-99 评分系统来评估复发的风险因素。结果 48 例患者中，32 例（67%）接受了 CRT 治疗，15 例（31%）接受了 EBRT 治疗，1 例（2%）仅接受了 VBT 治疗。CRT与EBRT/VBT的中位随访时间分别为63.2个月和28个月（P = 0.001）。在 CRT 组别中，4 例（12.5%）患者复发；2 例肺部孤立转移的患者获救，2 例多处转移的患者因病死亡。EBRT/VBT队列（n=16）中没有患者复发。CRT 和 EBRT/VBT 的估计 PFS 分别为 84.4% 和 100%（p = 0.392），CSS 分别为 93.7% 和 100%（p = 0.457）。结论在这项回顾性研究中，接受 EBRT/VBT 或 CRT 治疗的 HIR 子宫内膜癌和 ITC SLN 患者的生存率没有显著差异。有三个或三个以上 HIR 危险因素的患者尽管接受了 CRT 治疗，但仍有复发风险。进一步的前瞻性研究应评估伴有ITC的HIR EC的复发风险因素，可能会结合标准组织病理学和分子图谱来定制辅助CRT。

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Recurrence and survival in high-intermediate risk endometrial cancers with isolated tumor cell lymph node metastasis

Objective

To compare clinical outcomes of patients with early-stage, high-intermediate risk (HIR) endometrial cancer (EC) and isolated tumor cells (ITC) lymph node metastases treated with chemotherapy/radiotherapy (CRT) vs. external beam radiotherapy (EBRT)/vaginal brachytherapy (VBT).

Methods

We retrospectively identified all patients with early-stage HIR endometrioid EC and ITC treated with CRT or EBRT from our institutional database (January-2015 to December-2023). All patients underwent sentinel lymph node (SLN) assessments per NCCN guidelines. Progression-free survival (PFS) and cancer specific survival (CSS) were analyzed using Kaplan-Meier method. We utilized a GOG-99 scoring system in the HIR-ITC cohort to assess risk factors for recurrence.

Results

48 patients were identified, 32(67 %) treated with CRT, 15(31 %) with EBRT and 1(2 %) with VBT alone. Median follow-up was 63.2 and 28 months in CRT vs EBRT/VBT, respectively (p = 0.001). In CRT cohort, 4(12.5 %) recurred; two patients with isolated lung metastasis were salvaged and two with multiple sites of metastasis died with disease. No patient in EBRT/VBT cohort (n = 16) recurred. Estimated PFS were 84.4 % and 100 % for CRT and EBRT/VBT, respectively (p = 0.392), and CSS were 93.7 % vs. 100 %, respectively (p = 0.457). Using HIR scoring per GOG-99, 21(66 %) patients in CRT cohort had three or more HIR risk factors and 4(19 %) recurred despite adjuvant therapy.

Conclusion

In this retrospective study, there was no significant difference in survival for patients with HIR endometrial cancer and ITC SLNs treated with either EBRT/VBT or CRT. Patients with three or more HIR risk factors remain at risk for recurrence despite CRT. Further prospective studies should assess recurrence risk factors in HIR EC with ITC, likely incorporating standard histopathology and molecular profiles to tailor adjuvant CRT.

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来源期刊

Gynecologic Oncology Reports OBSTETRICS & GYNECOLOGY-

CiteScore

2.00

自引率

0.00%

发文量

183

审稿时长

41 days

期刊介绍： Gynecologic Oncology Reports is an online-only, open access journal devoted to the rapid publication of narrative review articles, survey articles, case reports, case series, letters to the editor regarding previously published manuscripts and other short communications in the field of gynecologic oncology. The journal will consider papers that concern tumors of the female reproductive tract, with originality, quality, and clarity the chief criteria of acceptance.