Clinicopathologic Characteristics, Molecular Profile, Treatment, and Recurrence in Endometrial Cancer with Pelvic Lymph Node Isolated Tumor Cells
4 affiliations
- 1Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- 2Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada
- 3Cross Cancer Institute, Department of Oncology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- 4Cross Cancer Institute, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
Abstract
Objective: Our objective was to characterize the molecular–pathologic profile and recurrence patterns of endometrial cancer with pelvic lymph node isolated tumor cells (ITCs). Methods: A single-center retrospective study of patients with endometrial cancer and ITCs was conducted. Patients with concurrent lymph nodes or distant metastasis were excluded. Cases were reviewed by a gynecologic pathologist, and electronic medical records were reviewed. Descriptive statistics were performed using R 4.4.2. Results: A total of 43 patients were included, with a median follow-up time of 33 months. The majority were endometrioid carcinoma (91%) and stage I (72%). In total, 28 (65%) were MMR-proficient and p53-wild-type (MMRp p53wt), nine (21%) were MMR-deficient (MMRd), six (14%) were p53-abnormal (p53abn), and none were POLE-mutated (POLEmut). Additionally, 27 (96%) MMRp p53wt cases showed a microcystic, elongated, and fragmented (MELF) pattern of invasion. Adjuvant therapy was indicated in 38 (88%) patients; 32 (74%) received therapy and six (14%) declined. Four (9.3%) patients recurred, with a recurrence rate of 33% (2/6) for p53abn, 11% (1/9) for MMRd, and 4% (1/28) for MMRp p53wt. All recurrences were to distant sites. In the MMRp p53wt group, 16 (57%) had external beam radiation (EBRT) +/− vaginal brachytherapy (VBT), three (11%) had chemotherapy +/− radiation, and nine (32%) had no adjuvant treatment or VBT alone. Conclusions: Molecular profile is prognostically relevant in endometrial carcinoma with ITCs. ITCs in MMRp p53wt endometrioid carcinoma present a low risk of disease recurrence. As the majority of our cohort received adjuvant therapy, future work may explore de-escalating treatment in low-risk ITC cases.
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BibTeX
@article{frerichs2026clinicopathologic,
title = {{Clinicopathologic Characteristics, Molecular Profile, Treatment, and Recurrence in Endometrial Cancer with Pelvic Lymph Node Isolated Tumor Cells}},
author = {Haley D. Frerichs and Cheng-Han Lee and Ericka Wiebe and Sophia Pin},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18203293},
url = {https://www.mdpi.com/2072-6694/18/20/3293},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinicopathologic Characteristics, Molecular Profile, Treatment, and Recurrence in Endometrial Cancer with Pelvic Lymph Node Isolated Tumor Cells
AU - Haley D. Frerichs
AU - Cheng-Han Lee
AU - Ericka Wiebe
AU - Sophia Pin
PY - 2026
DA - 2026/10/01
JO - Cancers
DO - 10.3390/cancers18203293
UR - https://www.mdpi.com/2072-6694/18/20/3293
AB - Objective: Our objective was to characterize the molecular–pathologic profile and recurrence patterns of endometrial cancer with pelvic lymph node isolated tumor cells (ITCs). Methods: A single-center retrospective study of patients with endometrial cancer and ITCs was conducted. Patients with concurrent lymph nodes or distant metastasis were excluded. Cases were reviewed by a gynecologic pathologist, and electronic medical records were reviewed. Descriptive statistics were performed using R 4.4.2. Results: A total of 43 patients were included, with a median follow-up time of 33 months. The majority were endometrioid carcinoma (91%) and stage I (72%). In total, 28 (65%) were MMR-proficient and p53-wild-type (MMRp p53wt), nine (21%) were MMR-deficient (MMRd), six (14%) were p53-abnormal (p53abn), and none were POLE-mutated (POLEmut). Additionally, 27 (96%) MMRp p53wt cases showed a microcystic, elongated, and fragmented (MELF) pattern of invasion. Adjuvant therapy was indicated in 38 (88%) patients; 32 (74%) received therapy and six (14%) declined. Four (9.3%) patients recurred, with a recurrence rate of 33% (2/6) for p53abn, 11% (1/9) for MMRd, and 4% (1/28) for MMRp p53wt. All recurrences were to distant sites. In the MMRp p53wt group, 16 (57%) had external beam radiation (EBRT) +/− vaginal brachytherapy (VBT), three (11%) had chemotherapy +/− radiation, and nine (32%) had no adjuvant treatment or VBT alone. Conclusions: Molecular profile is prognostically relevant in endometrial carcinoma with ITCs. ITCs in MMRp p53wt endometrioid carcinoma present a low risk of disease recurrence. As the majority of our cohort received adjuvant therapy, future work may explore de-escalating treatment in low-risk ITC cases.
SN - 2072-6694
ER -