TOPLINE:

In a large observational analysis, the presence of isolated tumor cells (ITCs) in regional lymph nodes was associated with worse overall survival among patients with low-risk endometrial cancer who underwent surgery without adjuvant therapy. At 4 years, overall survival was 89.5% in patients with ITCs vs 96.3% in patients with no nodal metastasis, corresponding to a more than threefold higher risk for all-cause mortality, though the absolute difference in overall survival was modest.

METHODOLOGY:

• The prognostic significance of ITCs in regional lymph nodes in patients with low-risk endometrial cancer remains unclear.
• To better understand the significance of ITCs in this context, researchers analyzed patient data from the National Cancer Database from 2018 to 2022.
• The study included patients with cytology-negative low-risk endometrial cancer (grade 1-2 endometrioid histology, stage IA, and absence of lymphovascular space invasion): 271 patients had ITCs in regional lymph nodes and 43,289 patients had no lymph node metastasis.
• All patients underwent hysterectomy and lymph node evaluation without additional chemotherapy or radiotherapy, with a median follow-up of 3.1 years for the ITC group and 3.3 years for the node-negative group.
• The primary outcome was overall survival without adjuvant therapy, comparing patients with ITCs to those with no nodal metastasis.

TAKEAWAY:

• The 4-year overall survival rate was 89.5% for patients with ITCs vs 96.3% for those with no nodal metastasis.
• The presence of ITCs was associated with a higher risk for all-cause mortality than no nodal metastasis (hazard ratio [HR], 3.15; 95% CI, 2.04-4.87).
• In exploratory analyses, the survival gap persisted across subgroups, including patients aged 60 years or older (HR, 3.47), those with grade 1 endometrioid histology (HR, 3.77), and those with tumors of at least 4 cm (HR, 3.22).

IN PRACTICE:

“The presence of ITCs in regional lymph nodes was associated with decreased [overall survival] compared to no nodal metastasis” among patients with low-risk endometrial cancer who underwent surgery without adjuvant therapy, the authors concluded. “These statistics suggest that ITCs in regional lymph nodes may be prognostic in low-risk endometrial cancer.”

SOURCE:

The study, led by Koji Matsuo, MD, PhD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California in Los Angeles, was published online as a Research Letter in JAMA Oncology.

LIMITATIONS:

Importantly, cause of death was not available in the National Cancer Database, nor was anatomical recurrence site (ie lymph node). Other key limitations included the modest sample size, relatively limited follow-up (a median of 3.1 years) to assess long-term survival, and unmeasured confounders, such as lack of information on performance status, depth of myometrial tumor invasion (no vs inner-half myoinvasion), and molecular classification.

DISCLOSURES:

This study received support from the Ensign Endowment for Gynecologic Cancer Research. Michiko Kodama, MD, PhD, disclosed receiving personal fees from AstraZeneca, MSD, Aska Pharmaceutical, and Johnson & Johnson outside the submitted work. Lynda D. Roman, MD, disclosed receiving personal fees from Natera and GlaxoSmithKline during the conduct of the study. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.