Clinical significance of isolated tumor cells and micrometastasis in low‐grade, stage I endometrial cancer

Ultrastaging in endometrial cancer (EC) led to increased detection of isolated tumor cells (ITC, ≤0.2 mm) and micrometastases (MM, 0.2‐2 mm), with unclear effect on prognosis. Our aim was to characterize the impact of ITC and MM on the outcome of these patients. Methods Grade 1 to 2 stage I endometrioid EC patients with nodal ITC ( n  = 11) or MM ( n  = 12) between 2012 and 2018 were retrospectively compared to a matched group of lymph node negative ( n  = 18) patients based on age, body mass index, grade, myometrial invasion, and lymphovascular space invasion (LVI) status using propensity score analysis (1:1). Mann‐Whitney U tests were performed on continuous variables and χ 2 tests on categorical variables. Progression‐free survival (PFS) was the main endpoint. Results All MM and 81% of ITC had LVI. More ITC/MM patients received RT and chemotherapy (91.7% vs 18.4%; 70.8% vs 4.5%, respectively; P  < 0.01) without significant difference in treatment‐related toxicities (25% vs 27.3% grade 1%‐2% and 20.8% vs 9.1% grade 2‐3; P  = 0.538) or PFS (29.2 vs 25 months; P  = 0.828). Two distant recurrences occurred in MM patients after 2.5 years; one lung and one para‐aortic lymph node. Conclusion With adjuvant treatment, ITC/MM in otherwise well‐differentiated stage I endometrial cancer have similar outcomes to matched LN− patients.