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The Clinical Features of Recurrent Endometrial Cancer in Japan: Chemotherapy Instead of Radiotherapy as Postoperative Adjuvant Treatment
  1. Haruko Iwase, MD, PhD*,
  2. Seigi Furukawa, MD*,
  3. Takeshi Hirasawa, MD, PhD,
  4. Satoshi Asai, MD,
  5. Tatsuru Ohara, MD, PhD,
  6. Shinji Hosonuma, MD, PhD,
  7. Shinichi Endo, MD*,
  8. Yuki Tazo, MD, PhD*,
  9. Hidetaka Sato, MD, PhD*,
  10. Toshio Takada, MD, PhD*,
  11. Masahide Arai, MD, PhD*,
  12. Masae Ikeda, MD, PhD,
  13. Masako Shida, MD, PhD,
  14. Norihito Yoshioka, MD, PhD,
  15. Akiko Tozawa-Ono, MD, PhD,
  16. Nao Suzuki, MD, PhD,
  17. Mikio Mikami, MD, PhD and
  18. Takashi Onda, MD, PhD*
  1. *Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara;
  2. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara;
  3. Department of Obstetrics and Gynecology, St Marianna University School of Medicine, Kawasaki, Japan.
  1. Address correspondence and reprint requests to: Haruko Iwase, MD, PhD, Department of Obstetrics and Gynecology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252–0374, Japan. E-mail: haiwase{at}med.kitasato-u.ac.jp.

Abstract

Objective Chemotherapy is a standard adjuvant treatment after primary surgery for endometrial cancer in Japan. We aimed to characterize the clinical features of recurrent endometrial cancer (REC) patients in Japan.

Materials and Methods We retrospectively reviewed the medical records of 112 REC patients who were primarily treated at 1 of 3 university hospitals in Japan from 2005 to 2012. We analyzed overall survival since the first recurrence (R-OS) in accordance with several factors.

Results Median patient age was 64 years. The median follow-up period was 48 months. The distributions of cancer stage and histological subtype lacked distinctive features, and most patients had a high risk for recurrence at the time of the primary surgery. Although approximately 78% of patients received adjuvant chemotherapy, 85/112 patients (76%) experienced recurrence within 2 years after the initial treatment ended. For patients receiving adjuvant chemotherapy, regional lymph node (LN) and distant-site recurrence were more frequent (>40%) than vaginal or intra-abdominal recurrence. Median survival and 5-year R-OS were 27 months and 26.1%, respectively. The R-OS was significantly better for patients aged 65 years or older, those with negative peritoneal cytology at the time of primary surgery, those with recurrence within regional LN (eg, pelvic LN or para-aortic LN under the renal vein) and/or vagina, and those who underwent surgery and/or radiotherapy after recurrence. A multivariate analysis indicated that positive peritoneal cytology, a disease-free interval of less than 12 months, recurrent lesions in 2 or 3 areas, and treatment excluding surgery or radiotherapy were independent predictors of poor prognosis after recurrence.

Conclusions Adjuvant chemotherapy was insufficient to reduce the incidence of distant recurrence. The prognosis of patients recurred within regional LN and/or vagina was significantly better than that of patients with recurrence in other lesions because of treatment with surgery and/or radiotherapy. The disease-free interval was a significant prognostic factor for REC patients.

  • Endometrial cancer
  • Adjuvant chemotherapy
  • Recurrence site
  • Prognostic factor

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