Lymph node metastases in endometrial carcinoma: A modern assessment in the era of sentinel lymph node mapping and molecular subtyping Journal Article
| Authors: | Praiss, A. M.; Dagher, C.; Zhou, Q.; Iasonos, A.; Rios-Doria, E.; Abu-Rustum, N. R.; Chiang, S.; Momeni-Boroujeni, A.; Weigelt, B.; Ellenson, L. H.; Leitao, M. M. Jr; Mueller, J. J. |
| Article Title: | Lymph node metastases in endometrial carcinoma: A modern assessment in the era of sentinel lymph node mapping and molecular subtyping |
| Abstract: | Objective: 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. Methods: 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. Results: 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). Conclusions: 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. © 2024 Elsevier Inc. |
| Keywords: | endometrial cancer; sentinel lymph node mapping; isolated tumor cells; lymph node metastases; molecular classification |
| Journal Title: | Gynecologic Oncology |
| Volume: | 191 |
| ISSN: | 0090-8258 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-12-01 |
| Start Page: | 37 |
| End Page: | 44 |
| Language: | English |
| DOI: | 10.1016/j.ygyno.2024.09.012 |
| PROVIDER: | scopus |
| PUBMED: | 39332279 |
| PMCID: | PMC11637938 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed (In Conflict of Interest Statement) and PDF -- MSK corresponding author is Jennifer Mueller -- Source: Scopus |
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