Synapse - Prognosis of isolated tumor cells and use of molecular classification in early stage endometrioid endometrial cancer

Prognosis of isolated tumor cells and use of molecular classification in early stage endometrioid endometrial cancer Journal Article

Authors:	Rios-Doria, E.; Abu-Rustum, N. R.; Alektiar, K. M.; Makker, V.; Liu, Y. L.; Zamarin, D.; Friedman, C. F.; Aghajanian, C.; Ellenson, L. H.; Chiang, S.; Weigelt, B.; Mueller, J. J.; Leitao, M. M.
Article Title:	Prognosis of isolated tumor cells and use of molecular classification in early stage endometrioid endometrial cancer
Abstract:	Objective We assessed the prognosis and molecular subtypes of early stage endometrioid endometrial cancer with isolated tumor cells within sentinel lymph nodes (SLNs) compared with node negative disease. Methods Patients diagnosed with stage IA, IB, or II endometrioid endometrial cancer and primary surgical management were identified from January 1, 2007 to December 31, 2019. All SLNs underwent ultrastaging according to the institutional protocol. Patients with cytokeratin positive cells, micrometastases, and macrometastases were excluded. Clinical, pathology, and molecular subtype data were reviewed. Results Overall, 1214 patients with early stage endometrioid endometrial cancer met the inclusion criteria, of whom 1089 (90%) had node negative disease and 125 (10%) had isolated tumor cells. Compared with node negative disease, the presence of isolated tumor cells had a greater association with deep myometrial invasion, lymphovascular space invasion, receipt of adjuvant therapy, and adjuvant chemotherapy with or without radiation (p<0.01). There was no significant difference in survival rates between patients with isolated tumor cells and node negative disease (3 year progression free survival rate 94% vs 91%, respectively, p=0.21; 3 year overall survival rate 98% vs 96%, respectively, p=0.45). Progression free survival did not significantly differ among patients with isolated tumor cells who received no adjuvant therapy or chemotherapy with or without radiation (p=0.31). There was no difference in the distribution of molecular subtypes between patients with isolated tumor cells (n=28) and node negative disease (n=194; p=0.26). Three year overall survival rates differed significantly when stratifying the entire cohort by molecular subtype (p=0.04). Conclusions Patients with isolated tumor cells demonstrated less favorable uterine pathologic features and received more adjuvant treatment with similar survival compared with patients with nodenegative disease. Among the available data, molecular classification did not have a significant association with the presence of isolated tumor cells, although copy number-high status was a poor prognostic indicator in early stage endometrioid endometrial cancer. © IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords:	adult; cancer chemotherapy; cancer survival; controlled study; human tissue; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; overall survival; cancer recurrence; adjuvant therapy; cancer staging; follow up; antineoplastic agent; endometrioid carcinoma; endometrial neoplasms; neoplasm staging; endometrium cancer; sentinel lymph node; dna polymerase; cytology; progression free survival; classification; cohort analysis; pathology; surgical approach; retrospective study; micrometastasis; external beam radiotherapy; cytokeratin; endometrium tumor; carcinoma, endometrioid; cell invasion; therapy; uterine cancer; copy number variation; cancer prognosis; very elderly; humans; prognosis; human; female; article
Journal Title:	International Journal of Gynecological Cancer
Volume:	34
Issue:	9
ISSN:	1048-891X
Publisher:	Lippincott Williams & Wilkins
Date Published:	2024-09-01
Start Page:	1373
End Page:	1381
Language:	English
DOI:	10.1136/ijgc-2024-005522
PUBMED:	38782452
PROVIDER:	scopus
PMCID:	PMC12044596
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85194279684&doi=10.1136%2fijgc-2024-005522&partnerID=40&md5=f7acfc43355bf041f2bebffe874655d1
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Mario M Leitao -- Source: Scopus