Endometrial cancer (EC) is the most diagnosed gynecologic malignancy, and its incidence and mortality are increasing. The prognosis is highly dependent on the disease spread. Surgical staging includes retroperitoneal evaluation to detect potential lymph node metastases. In recent years, systematic lymphadenectomy has been replaced by sentinel lymph node (SLN) biopsy and ultrastaging, allowing for the detection of macrometastases, micrometastases, and isolated tumor cells (ITCs). Micrometastases and ITCs have been grouped as low-volume metastases (LVM). The reported prevalence of LVM in studies enrolling more than one thousand patients with apparent early-stage EC ranges from 1.9% to 10.2%. Different rates of LVM are observed when patients are stratified according to disease characteristics and their risk of recurrence. Patients with EC at low risk for recurrence have low rates of LVM, while intermediate- and high-risk patients have a higher likelihood of being diagnosed with nodal metastases, including LVM. Macro- and micrometastases increase the risk of recurrence and cause upstaging, while the clinical significance of ITCs is still uncertain. A recent meta-analysis found that patients with LVM have a higher relative risk of recurrence [1.34 (95% CI: 1.07–1.67)], regardless of adjuvant treatment. In a retrospective study on patients with low-risk EC and no adjuvant treatment, those with ITCs had worse recurrence-free survival compared to node-negative patients (85.1%; CI 95% 73.8–98.2 versus 90.2%; CI 95% 84.9–95.8). However, a difference was no longer observed after the exclusion of cases with lymphovascular space invasion. There is no consensus on adjuvant treatment in ITC patients at otherwise low risk, and their recurrence rate is low. Multi-institutional, prospective studies are warranted to evaluate the clinical significance of ITCs in low-risk patients. Further stratification of patients, considering histopathological and molecular features of the disease, may clarify the role of LVM and especially ITCs in specific contexts.
子宫内膜癌是最常见的妇科恶性肿瘤，其发病率和死亡率呈上升趋势。该疾病的预后高度依赖于病灶扩散范围。手术分期包括腹膜后评估以检测潜在的淋巴结转移。近年来，系统性淋巴结清扫术已被前哨淋巴结活检及超分期技术所取代，该技术能够检测出宏转移、微转移及孤立肿瘤细胞。微转移与孤立肿瘤细胞被归类为低负荷转移。在纳入超过千名早期子宫内膜癌患者的研究中，低负荷转移的检出率介于1.9%至10.2%之间。根据疾病特征及复发风险对患者进行分层时，可观察到不同的低负荷转移发生率。低复发风险患者的低负荷转移率较低，而中高风险患者被诊断为淋巴结转移（包括低负荷转移）的可能性更高。宏转移与微转移会增加复发风险并导致分期升级，而孤立肿瘤细胞的临床意义尚不明确。近期一项荟萃分析发现，无论是否接受辅助治疗，低负荷转移患者的复发相对风险更高[1.34（95% CI：1.07–1.67）]。一项针对低风险子宫内膜癌且未接受辅助治疗患者的回顾性研究显示，与淋巴结阴性患者相比（90.2%；95% CI 84.9–95.8），存在孤立肿瘤细胞患者的无复发生存率更低（85.1%；95% CI 73.8–98.2）。但排除淋巴脉管间隙浸润病例后，该差异不再显著。对于其他方面风险较低但存在孤立肿瘤细胞的患者，辅助治疗尚未形成共识，且其复发率较低。有必要开展多中心前瞻性研究以评估孤立肿瘤细胞在低风险患者中的临床意义。结合疾病的组织病理学和分子特征对患者进行进一步分层，可能有助于明确低负荷转移（特别是孤立肿瘤细胞）在特定临床背景中的作用。
肿瘤(癌症)患者之家