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Prediction of Site-Specific Tumor Relapses in Patients With Stage I–II Endometrioid Endometrial Cancer
  1. Taru Tuomi, MD*,
  2. Annukka Pasanen, MD,
  3. Arto Leminen, MD, PhD*,
  4. Ralf Bützow, MD, PhD and
  5. Mikko Loukovaara, MD, PhD*
  1. *Departments of Obstetrics and Gynecology and
  2. Departments of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  1. Address correspondence and reprint requests to Taru Tuomi, MD, Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00029 HUS, Helsinki, Finland. E-mail: taru.tuomi@fimnet.fi.

Abstract

Objective The aim of this study was to investigate the association of predictors of an advanced disease and/or poor outcome with the occurrence of tumor relapses in different anatomical sites in patients with stage I–II endometrioid endometrial cancer.

Methods A total of 929 patients were included in the study. The median follow-up time was 57 months (range, 1–108 months). The studied variables were: poor tumor differentiation, myometrial invasion 50% or greater, tumor size 3 cm or greater, lymphovascular space invasion, cervical stromal invasion, positive peritoneal cytology, old age (>77 years), obesity (body mass index ≥30 kg/m2), and diabetes.

Results A relapse was diagnosed in 98 patients (10.5%) (vaginal in 15, pelvic in 27, intra-abdominal beyond the pelvis in 27, extra-abdominal in 29). None of the variables were associated with an altered risk of vaginal or pelvic relapses in univariate analyses. Poor differentiation, myometrial invasion 50% or greater, tumor size 3 cm or greater, and positive peritoneal cytology were associated with an increased risk of intra-abdominal relapses beyond the pelvis (odds ratios [ORs] between 2.2 and 9.6). With the exception of obesity and diabetes, all variables were associated with an increased risk of extra-abdominal relapses (ORs between 2.3 and 13). Tumor size 3 cm or greater (OR, 3.1) and positive peritoneal cytology (OR, 16) predicted intra-abdominal relapses beyond the pelvis in multivariate analysis, whereas poor differentiation (OR, 2.9), myometrial invasion 50% or greater (OR, 4.0), and positive peritoneal cytology (OR, 27) predicted extra-abdominal relapses. Compared with vaginal relapses, intra-abdominal relapses beyond the pelvis and extra-abdominal relapses were associated with a worse disease-specific survival. Survival of patients with a pelvic relapse did not differ from that of patients with a vaginal relapse.

Conclusions Risk variables of endometrial cancer are differently associated with relapses in different locations. Our findings may promote studies that explore the most efficient adjuvant therapy in high-risk early-stage endometrioid endometrial cancer.

  • Demographic factors
  • Endometrial cancer
  • Peritoneal cytology status
  • Relapse
  • Uterine risk factors

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Footnotes

  • This study was supported by Helsinki University Hospital research funds.

  • The authors declare no conflicts of interest.

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