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Uterine Cancer
A Proposal for a Classification for Recurrent Endometrial Cancer: Analysis of a French Multicenter Database From the FRANCOGYN Study Group
  1. Alexandre Bricou, MD*,
  2. Sofiane Bendifallah, MD, PhD†,
  3. Mathilde Daix-Moreux, MD*,
  4. Lobna Ouldamer, MD, PhD‡,
  5. Vincent Lavoue, MD, PhD§,
  6. Amélie Benbara, MD*,
  7. Cyrille Huchon, MD, PhD∥,
  8. Geoffroy Canlorbe, MD, PhD†,
  9. Emilie Raimond, MD,
  10. Charles Coutant, MD, PhD#,
  11. Olivier Graesslin, MD, PhD,
  12. Pierre Collinet, MD, PhD**,
  13. Xavier Carcopino, MD, PhD††,
  14. Cyril Touboul, MD, PhD‡‡,§§,
  15. Emile Daraï, MD, PhD†,
  16. Lionel Carbillon, MD, PhD* and
  17. Marcos Ballester, MD, PhD†
  1. *Department of Obstetrics and Gynecology, Jean-Verdier University Hospital, Assistance Publique des Hôpitaux de Paris, University Paris 13;
  2. †Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie;
  3. ‡Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours;
  4. §CRLCC Eugène-Marquis, Service de Gynécologie, CHU de Rennes, Université de Rennes 1;
  5. ∥Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal, Poissy;
  6. Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims;
  7. #Centre de Lutte Contre le Cancer Georges François Leclerc, Dijon;
  8. **Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire, Lille;
  9. ††Department of Obstetrics and Gynecology, Hôpital Nord, Marseille;
  10. ‡‡Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil; and
  11. §§Faculté de Médecine de Créteil, UPEC—Paris XII, Paris, France.
  1. Address correspondence and reprint requests to Bricou Alexandre, MD, Department of Obstetrics and Gynecology, Jean-Verdier University Hospital, Assistance Publique des Hôpitaux de Paris, University Paris 13, Avenue du 14 Juillet, 93143 Bondy Cedex, France. E-mail: alexandre.bricou{at}aphp.fr.

Abstract

Objective Endometrial cancer (EC) recurrences are relatively common with no standardized way of describing them. We propose a new classification for them called locoregional, nodal, metastasis, carcinomatosis recurrences (rLMNC).

Patients and Methods The data of 1230 women with EC who were initially treated by primary surgery were included in this French multicenter retrospective study. Recurrences were classified based on dissemination pathways: (1) locoregional recurrence (rL); (2) nodal recurrence (rN) for lymphatic pathway; (3) distant organ recurrence (rM) for hematogenous pathway; and (4) carcinomatosis recurrence (rC) for peritoneal pathway. These pathways were further divided into subgroups. We compared recurrence free survival and overall survival (OS) between the 4 groups (rL/rN/rM/rC).

Results The median follow-up was 35.6 months (range, 1.70–167.60). One hundred ninety-eight women (18.2%) experienced a recurrence: 150 (75.8%) experienced a single-pathway recurrence and 48 (24.2%) a multiple-pathway recurrence. The 5-year OS was 34.1% (95% confidence interval [CI], 27.02%–43.1%), and the median time to first recurrence was 18.9 months (range, 0–152 months). The median survival after recurrence was 14.8 months (95% CI, 11.7–18.8). Among women with single pathway of recurrence, a difference in 5-year OS (P < 0.001) and survival after recurrence (P < 0.01) was found between the 4 rLNMC groups. The carcinomatosis group had the worst prognosis compared with other single recurrence pathways. Women with multiple recurrences had poorer 5-year OS (P < 0.001) and survival after recurrence (P < 0.01) than those with single metastasis recurrence, other than women with peritoneal carcinomatosis.

Conclusions This easy-to-use and intuitive classification may be helpful to define EC recurrence risk groups and develop guidelines for the management of recurrence. Its prognosis value could also be a tool to select homogenous populations for further trials.

  • Endometrial cancer
  • Recurrences
  • Relapses
  • Classification

https://doi.org/10.1097/IGC.0000000000001296

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    Footnotes

    • The authors declare no conflict of interest.

    • Clinical trial identification number: CEROG 2014-GYN-020.

    • URL of the registration site: http://www.cngof.fr/accueil-cngof/le-cerog.

    • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.ijgc.net).