ObjectiveTo evaluate the recurrence rates and patterns of failure in patients with stage I endometrial carcinoma after surgical staging without adjuvant therapy.MethodsMedical records of 229 patients with stage I endometrial carcinoma, treated with surgery alone between 2002 and 2010 at Siriraj Hospital were retrospectively reviewed. The primary objective of this study was recurrence rates. The secondary objectives were patterns of failure, disease-free survival, overall survival, and prognostic factors related to outcomes.ResultsDuring median follow-up time of 53.3 months, 11 recurrences (4.8%) occurred with a median time to recurrence of 21.2 months (range, 7.7 to 77.8 months). Vaginal recurrence was the most common pattern of failure (8/11 patients, 72.7%). Other recurrences were pelvic, abdominal and multiple metastases. Factors that appeared to be prognostic factors on univariate analyses were age and having high intermediate risk (HIR) (Gynecologic Oncology Group [GOG] 99 criteria), none of which showed significance in multivariate analysis. The recurrence rates were higher in the patients with HIR criteria (22.2% vs. 4.1%, p=0.013) or patients with stage IB, grade 2 endometrioid carcinoma (9.4% vs. 4.3%, p=0.199). Five-year disease-free survival and 5-year overall survival were 93.9% (95% CI, 89.9 to 5.86) and 99.5% (95% CI, 97.0 to 99.9), respectively.ConclusionThe patients with low risk stage I endometrial carcinoma had excellent outcomes with surgery alone. Our study showed that no single factor was demonstrated to be an independent predictor for recurrence.

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Aim To compare clinical characteristics and identify factors predictive of resistance to initial treatment with methotrexate‐folinic acid (MTX‐FA) in women with low‐risk gestational trophoblastic neoplasia (GTN). Methods Retrospective chart reviews were conducted in patients diagnosed with low‐risk GTN who were treated with MTX‐FA at Siriraj Hospital between 2002 and 2018. Demographic data, disease characteristics, treatment response, toxicity, and data of the subsequent pregnancy were collected and analyzed. Groups of patients who were responsive or resistant to treatment were compared. Stepwise logistic regression analysis was used to identify factors predictive of resistance to methotrexate chemotherapy. Results Totally, 113 patients were eligible for analysis. The primary remission rate was 55.8% with first‐line MTX‐FA. All other patients achieved remission by subsequent treatment with actinomycin D or multiple‐agent chemotherapy. Relapse of disease occurred in 4.4% and the overall survival rate was 99.1%. Univariate analysis showed that pretreatment serum hCG, neutrophil‐to‐lymphocyte ratio at baseline, and serum hCG ratio of the first three consecutive cycles (C) were significantly associated with resistance to MTX‐FA. Independent factors that predict failure to respond to first‐line MTX‐FA were pretreatment serum hCG ≥15,000 IU/L, a less than 4.8‐fold reduction of serum hCG between cycle 1 and cycle 2 (C1/C2), and a less than seven‐fold reduction of serum hCG from cycle 2 to cycle 3 (C2/C3). Conclusions First‐line MTX‐FA treatment is effective in 55.8% of patients. Pretreatment serum hCG, and serum hCG ratio between consecutive treatment cycles can predict initial treatment failure.