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  • Why Routine Clinical Follow-up for Patients With Early Stage Endometrial Cancer Is Not Always Necessary: A Study on Women in South Wales

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Uterine Cancer
Why Routine Clinical Follow-up for Patients With Early Stage Endometrial Cancer Is Not Always Necessary: A Study on Women in South Wales
  1. Lilly Aung, MBBCh†,
  2. Robert E.J. Howells, MD*,
  3. Kenneth C.K. Lim, MBBCh†,
  4. Emma Hudson, MBBCh‡ and
  5. Peter W. Jones, PhD§
  1. *Welsh Regional Centre for Gynaecological Oncology, University Hospital of Wales, Llandough, Cardiff;
  2. †Department of Obstetrics and Gynaecology, Royal Gwent Hospital, Newport;
  3. ‡Department of Clinical and Medical Oncology, Velindre Hospital NHS Trust, Velindre, Cardiff; and
  4. §Health Services Research Unit, Keele University, Keele, Staffordshire, United Kingdom.
  1. Address correspondence and reprint requests to Robert E.J. Howells, MD, Welsh Regional Centre for Gynaecological Oncology, University Hospital of Wales, Llandough, Penlan Rd, Llandough, Cardiff, Vale of Glamorgan, United Kingdom CF64 2XX. E-mail: roberthowells{at}wales.nhs.uk.

Abstract

Objective This study aimed to examine the existing methods of follow-up in women who have undergone treatment of early endometrial carcinoma in South Wales and to assess if they are appropriate.

Design This study used a retrospective analysis of follow-up data.

Setting This study was performed in the Virtual Gynaecological Oncology Centre, South Wales, United Kingdom.

Sample This study sample is composed of 552 women.

Methods Data regarding follow-up were collected retrospectively from patient case notes and computerized data systems. Data were analyzed using the Pearson χ2 test, Cox proportional hazard regression analysis, and Kaplan-Meier curves.

Main Outcome Measures This study aimed to determine whether routine follow-up was beneficial in detecting disease recurrence and whether outcome was influenced by routine follow-up.

Results Between January 1, 2000, and December 31, 2010, 552 women were treated for early stage endometrial carcinoma. The 5-year survival was 81%, and the 5-year progression-free survival was 77%. Of these 552 women, 81 (15%) developed a disease recurrence; the majority (61/81 [75%]) recurred within 3 years. The median survival was 35 months compared with 47 months in patients who did not develop a recurrence. Of the 81 patients, 73 (90%) were symptomatic and only 5 patients were truly asymptomatic at follow-up. The most important and significant prognostic factor was “recurrent disease” with overall survival (hazard ratio, 2.20; P < 0.001; 95% confidence interval, 1.75–2.65) and progression-free survival (hazard ratio, 2.52; P < 0.001; 95% confidence interval, 2.09–2.95). “Asymptomatic recurrence” was not an independent predictor of outcome.

Conclusions Routine follow-up for early endometrial cancer is not beneficial for patients because most were symptomatic at the time of detection. It does not significantly improve the outcome. We propose altering the follow-up time regimen and adopting alternative follow-up strategies for women in South Wales.

  • Follow-up
  • Routine

https://doi.org/10.1097/IGC.0000000000000088

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    Footnotes

    • The authors declare no conflicts of interest.

    • Contribution to authorship: L.A., R.H., K.L., and E.H. came up with the idea for the study. L.A. was responsible for the collection of data. R.H. and P.J. were responsible for the analysis of data. L.A., R.H., K.L., and E.H. were responsible for the interpretation and writing of the article. P.J. was responsible for the critical review.