研究动态
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MILACC研究:是否未检测到的淋巴结微转移对LACC试验的复发率产生了影响?

MILACC study: could undetected lymph node micrometastases have impacted recurrence rate in the LACC trial?

发表日期:2023 Aug 31
作者: Roni Nitecki, Pedro T Ramirez, Pavel Dundr, Kristyna Nemejcova, Reitan Ribeiro, Mariano Tamura Vieira Gomes, Ronaldo Luis Schmidt, Lucio Bedoya, David Ortiz Isla, Rene Pareja, Gabriel Jaime Rendón Pereira, Aldo Lopez, David Kushner, David Cibula
来源: Cellular & Molecular Immunology

摘要:

介绍:《LACC试验中早期宫颈癌腹腔镜手术相关的肿瘤学结局不佳的病因尚不清楚。对先前未被识别出来的低负荷疾病进行淋巴结操作可能解释了这一发现。我们通过病理超分析重新对LACC试验中复发的淋巴结阴性患者的淋巴结进行分析。被纳入研究的患者来源于LACC试验数据库,常规病理评估显示淋巴结阴性,并且复发至腹腔和/或骨盆。没有复发或没有可用淋巴结组织的患者被排除在外。按照标准超分析协议对完整的所有淋巴结组织块和玻璃片进行重新分析,以检测微转移(>0.2 mm 和 ≤2 mm)和孤立的肿瘤细胞(聚集数量多于0.2 mm 或小于200个细胞)。 该研究纳入了20例患者,中位年龄为42岁(30-68岁)。大多数患者经过随机分组接受了微创手术(90%),患有鳞状细胞癌(65%),FIGO 2009年1B1期(95%),2级(60%)疾病,无辅助治疗(75%)且复发仅限于一个部位(55%),最常见的是阴道颈部(45%)。只有一例患者在没有其他病灶的情况下出现了骨盆壁复发。每位患者平均分析了18.5个(4-32个)淋巴结,总计412个淋巴结。通过超分析协议,中央部门对621个系列和1242片玻璃片进行了查看。在任何淋巴结中都未发现任何大小的转移性疾病。 在LACC试验中复发的淋巴结阴性患者中,没有发现淋巴结微小的体积转移。因此,对于LACC试验微创组中较高局部复发风险的潜在原因是不太可能的淋巴结操作包含临床上未检测出的转移的可能性。©IGCS和ESGO 2023. 不允许商业再利用。由BMJ出版。
The etiology of inferior oncologic outcomes associated with minimally invasive surgery for early-stage cervical cancer remains unknown. Manipulation of lymph nodes with previously unrecognized low-volume disease might explain this finding. We re-analyzed lymph nodes by pathologic ultrastaging in node-negative patients who recurred in the LACC (Laparoscopic Approach to Cervical Cancer) trial.Included patients were drawn from the LACC trial database, had negative lymph nodes on routine pathologic evaluation, and recurred to the abdomen and/or pelvis. Patients without recurrence or without available lymph node tissue were excluded. Paraffin tissue blocks and slides from all lymph nodes removed by lymphadenectomy were re-analyzed per standard ultrastaging protocol aimed at the detection of micrometastases (>0.2 mm and ≤2 mm) and isolated tumor cells (clusters up to 0.2 mm or <200 cells).The study included 20 patients with median age of 42 (range 30-68) years. Most patients were randomized to minimally invasive surgery (90%), had squamous cell carcinoma (65%), FIGO 2009 stage 1B1 (95%), grade 2 (60%) disease, had no adjuvant treatment (75%), and had a single site of recurrence (55%), most commonly at the vaginal cuff (45%). Only one patient had pelvic sidewall recurrence in the absence of other disease sites. The median number of lymph nodes analyzed per patient was 18.5 (range 4-32) for a total of 412 lymph nodes. A total of 621 series and 1242 slides were reviewed centrally by the ultrastaging protocol. No metastatic disease of any size was found in any lymph node.There were no lymph node low-volume metastases among patients with initially negative lymph nodes who recurred in the LACC trial. Therefore, it is unlikely that manipulation of lymph nodes containing clinically undetected metastases is the underlying cause of the higher local recurrence risk in the minimally invasive arm of the LACC trial.© IGCS and ESGO 2023. No commercial re-use. See rights and permissions. Published by BMJ.