J Gynecol Oncol.  2017 Sep;28(5):e65. 10.3802/jgo.2017.28.e65.

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

• Topfedaisi Ozkan N
• Meydanlı
• Sarı ME
• Demirkiran F
• Kahramanoglu I
• Bese T
• Arvas M
• Åžahin H
• Haberal A
• Celik H
• Coban G
• Oge T
• Yalcin OT
• Akbayır Ã
• Erdem B
• NumanoÄŸlu C
• Özgül N
• Boyraz G
• Salman MC
• Yüce K
• Dede M
• Yenen MC
• TaÅŸkın S
• Altın D
• Ortaç UF
• Aydın Ayık H
• ÅžimÅŸek T
• Güngör T
• Güngördük K
• Sancı M
• Ayhan A

• KMID: 2413225
• DOI: http://doi.org/10.3802/jgo.2017.28.e65

Abstract

OBJECTIVE
To determine factors influencing overall survival following recurrence (OSFR) in women with low-risk endometrial cancer (EC) treated with surgery alone.
METHODS
A 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.
RESULTS
We 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.
CONCLUSION
Low-risk EC patients recurring earlier than 36 months and those carrying HIR criteria seem more likely to succumb to their tumors after recurrence.

Keyword

Endometrial Neoplasms; Recurrence; Local Neoplasm Recurrence; Survival Analysis

MeSH Terms

Aged
Carcinoma, Endometrioid/mortality/pathology/surgery
Endometrial Neoplasms/*mortality/pathology/*surgery
Female
Humans
Hysterectomy
Lymph Node Excision
Middle Aged
Myometrium
Neoplasm Recurrence, Local/*mortality
Proportional Hazards Models
Retrospective Studies
Risk Factors
Salpingo-oophorectomy
Time Factors
Turkey