Factors associated with survival after relapse in patients with low-risk endometrial cancer treated with surgery alone

Abstract

ObjectiveTo determine factors influencing overall survival following recurrence (OSFR) in women with low-risk endometrial cancer (EC) treated with surgery alone.MethodsA multicenter, retrospective department database review was performed to identify patients with recurrent “low-risk EC” (patients having less than 50% myometrial invasion [MMI] with grade 1 or 2 endometrioid EC) at 10 gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected.ResultsWe identified 67 patients who developed recurrence of their EC after initially being diagnosed and treated for low-risk EC. For the entire study cohort, the median time to recurrence (TTR) was 23 months (95% confidence interval [CI]=11.5–34.5; standard error [SE]=5.8) and the median OSFR was 59 months (95% CI=12.7–105.2; SE=23.5). We observed 32 (47.8%) isolated vaginal recurrences, 6 (9%) nodal failures, 19 (28.4%) peritoneal failures, and 10 (14.9%) hematogenous disseminations. Overall, 45 relapses (67.2%) were loco-regional whereas 22 (32.8%) were extrapelvic. According to the Gynecologic Oncology Group (GOG) Trial-99, 7 (10.4%) out of 67 women with recurrent low-risk EC were qualified as high-intermediate risk (HIR). The 5-year OSFR rate was significantly higher for patients with TTR ≥36 months compared to those with TTR <36 months (74.3% compared to 33%, p=0.001). On multivariate analysis for OSFR, TTR <36 months (hazard ratio [HR]=8.46; 95% CI=1.65–43.36; p=0.010) and presence of HIR criteria (HR=4.62; 95% CI=1.69–12.58; p=0.003) were significant predictors.ConclusionLow-risk EC patients recurring earlier than 36 months and those carrying HIR criteria seem more likely to succumb to their tumors after recurrence.

Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer

“…It should be emphasized that low-risk endometrial cancer patients may be qualified as high-intermediate risk with the contribution of age (>70 years), grade of the tumor (grade 2), and/or positive lymphovascular space invasion status 6. Aristizabal et al33 reported a retrospective analysis of 518 patients (198 lymphovascular space invasion-positive tumors and 310 lymphovascular space invasion-negative tumors) with stage I endometrial cancer.…”

“…Among women with endometrioid endometrial cancer, low-risk endometrial cancer represents the largest group,5 and the rate of low-risk endometrial cancer has been reported as 40.5% among all endometrioid endometrial cancers in Turkey 6. Low-risk endometrial cancer has a good outcome, particularly in young women, and the 5-year survival rate has been reported to be 96% 7.…”

Risk Factors for Recurrence in Low-Risk Endometrial Cancer: A Case-Control Study

“…Similarly, those studies were not different from the current data that half of the recurrences are vaginal, followed by peritoneal, hematogenous, and lymphatic spread [16]. A significant portion of the recurrences in patients with endometrioid EC occur within the first 2 years (37.5% of patients recurred within the first year, 54.2% within the second year, and 8.3% within the third year) [10].…”

Prognostic factors and patterns of recurrence in lymphovascular space invasion positive women with stage IIIC endometriod endometrial cancer

“…Patient data were extracted from five institutions with maintained EC databases. These five centers (all of them participated in our previous multicenter studies on EC) were chosen because of their high volume of endometrioid EC presentations. Some of the patients in this study were within the context of one of our previous studies .…”

“…The date of diagnosis, adjuvant treatment modality (radiotherapy, chemoradiotherapy or chemotherapy), recurrence (if applicable), time to recurrence (TTR) (as a continuous variable in months, if applicable), site of recurrence (locoregional, retroperitoneal, distant), length of follow up and survivals were noted. Data were collected from centers with an online standardized form …”