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A prospective population-based management program including primary surgery and postoperative risk assessment by means of DNA ploidy and histopathology. Adjuvant radiotherapy is not necessary for the majority of patients with FIGO stage I–II endometrial cancer
  1. T. HOGBERG*,
  3. P. ALM,
  5. G. LARSSON,
  6. C. OTTOSEN**,
  7. L. SVANBERG†† and
  8. B. LINDAHL‡‡
  9. On behalf of the Southern Swedish Gynecologic Oncology Group
  1. *Department of Gynecologic Oncology, University Hospital, Linkoping, Sweden
  2. Department of Gynecologic Oncology, University Hospital, Lund, Sweden
  3. Department of Pathology, University Hospital, Lund, Sweden
  4. §Oncology Laboratory, Department of Oncology, University Hospital, Lund, Sweden
  5. Department of Obstetrics and Gynecology, Karlskrona Hospital, Karlskrona, Sweden
  6. **Department of Obstetrics and Gynecology, Helsingborg Hospital, Helsingborg, Sweden
  7. ††Department of Obstetrics and Gynecology, University Hospital, Malmö, Sweden
  8. ‡‡Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden
  1. Address correspondence and reprint requests to: Thomas Hogberg, Department of Gynecologic Oncology, University Hospital, SE 581 85 Linkoping, Sweden. Email: thomas.hogberg{at}


A management program for FIGO stage I–II nonserous, nonclear-cell adenocarcinomas was evaluated. Histopathology and DNA ploidy were used to estimate postoperatively the risk of progression or death of disease and to tailor treatment. The patient material was a population-based consecutive cohort of all women with endometrial cancer in the Southern Swedish Health Care Region diagnosed between June 1993 and June 1996 (n = 553). Of these, 335 were eligible for the management program. Patients estimated to be at low risk were treated by surgery only, while high-risk patients also received vaginal brachytherapy. A large low-risk group consisting of 84% (n = 283) of the patients with an estimated disease-specific 5-year survival of 96% (95% CI = 93–98%) was identified. The high-risk group (n = 52, 16%) showed a worse outcome with an 80% 5-year disease-specific survival (95% CI = 65–89%). The difference in survival between the groups was highly significant (P < 0.0001). Half of the progressions were distant in the high-risk group. Although there is a clear indication for adjuvant therapy for this group, locoregional radiotherapy could be expected to fail in cases with distant progression. Thus, effective systemic treatments need to be developed. Low-risk patients, constituting the majority (84%) of the patients, can be safely treated by surgery only.

  • endometrial neoplasms/therapy
  • ploidies
  • prospective studies
  • risk factors

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