Quantification of recurrence risk based on number of adverse prognostic factors in women with stage I uterine endometrioid carcinoma

Abstract

Objective: The goal was to develop an updated model to predict the risk of recurrence, based on the number of adverse pathologic features in women with International Federation of Gynecology and Obstetrics stage I uterine endometrioid carcinoma, who did not undergo any adjuvant treatment. Material and Methods: Women at a single center who underwent surgical staging without adjuvant therapy between January 1990 and December 2019 were included. Cox proportional hazards model was used to identify independent predictors of relapse free survival (RFS). Prognostic groups were then created based on the number of independent predictors of recurrence that were identified (0, 1, or 2-3 risk factors). Overall survival (OS) and disease specific survival (DSS) were also calculated for each group. Results: In total 1133 women were eligible for inclusion. Median follow-up was 84 months. Independent prognostic factors of recurrence included: age ≥60; grade 2 or 3 differentiation; and presence of lymphovascular space invasion (LVSI). Due to the small number of patients with either 2 or 3 risk factors, these groups were combined into one (group 2/3). Isolated vaginal cuff recurrence was the most common site of recurrence in all study groups (2%, 7%, and 17% for groups 0, 1, and 2/3, respectively). Five-year RFS rates were 96%, 85%, and 57% for groups 0, 1, and 2/3 (p<0.01), respectively. Five-year DSS rates were 99%, 96%, and 85% and 5-year OS rates were 94%, 85%, and 62% (p<0.01), respectively. Conclusion: We identified older age, high grade, and presence of LVSI as independent predictors of recurrence for women with stage I uterine endometrioid carcinoma. Using these prognostic factors, recurrence risk can be quantified for individual patients, and these factors can be used in deciding the appropriate adjuvant management course.

Recurrence Risk Stratification for Women With FIGO Stage I Uterine Endometrioid Carcinoma Who Underwent Surgical Lymph Node Evaluation

“…Several investigators reported that the presence of LVSI in women with early-stage uterine EC was an independent risk factors for survival endpoints such as RFS, DSS, and OS. However, they did include many patients in their studies who did not undergo SLNE 13,14,16,23 . In the current study, while the presence of LVSI was a significant predictor of worse for RFS, DSS, and OS on univariate analysis, it was not an independent risk factor of these survival endpoints on MVA after adjusting for other prognostic factors like grade and age.…”

“…Using Stepwise Model Selection only 3 factors were independent predictors of 5-year RFS: age ≥60 versus <60 years (HR: 2.12, 95% CI: 1.04-4.31; P =0.038), grade 2 versus 1 (HR: 2.88, 95% CI: 1.44-5.76; P =0.003), and grade 3 versus grade 1 (HR: 4.58, 95% CI: 1.89-11.10; P =0.0008), after adjusting for FIGO stage, LVSI, cervical mucosal involvement and body mass index. Due to limited number of patients with FIGO grade 3 tumors, (5.9%; n=42), we combined patients with grade 2 and 3 together in 1 group (high grade) similar to some other investigators 16 . Accordingly, and based on the number of recurrence risk factors, the study cohort was divided into 3 main groups: Group 0 (age <60 y and grade 1; n=274, 39%). Group 1 (age ≥60 y or grade 2/3; n=318, 45%). Group 2 (age ≥60 y and grade 2/3; n=114; 16%). …”

“…Due to limited number of patients with FIGO grade 3 tumors, (5.9%; n = 42), we combined patients with grade 2 and 3 together in 1 group (high grade) similar to some other investigators. 16 Accordingly, and based on the number of recurrence risk factors, the study cohort was divided into 3 main groups:…”

“…While useful, the study included patients without pelvic LN evaluation with only 59% of their patients underwent any sort of SLNE. 16 LVSI is a wellknown predictor of LN metastases as portrayed by many investigators. 17,18 Jorge et al 17 reported LN metastases risk ratio of 9.29 times higher for FIGO stage IA patients and 4.64 times for stage IB patients with versus without LVSI after adjusting for other factors.…”

“…They reported that older age, higher grade, and the presence of LVSI were all independent predictors for tumor recurrence. While useful, the study included patients without pelvic LN evaluation with only 59% of their patients underwent any sort of SLNE 16 . LVSI is a well-known predictor of LN metastases as portrayed by many investigators 17,18 .…”