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Abstract
Introduction/Background Our purpose is to evaluate the influence of surgical management and the prognostic factors for Disease-Free Survival (DFS) and Overall Survival (OS) in endometrial cancer (EC).
Methodology Retrospective review of 180 patients underwent standard surgical staging with pelvic and para-aortic lymphadenectomy in 130 cases. Mean age was 63 years (27–94). Mean BMI 30 kg/m2 (15–51). Mean Ca 1.25 prior to surgery was 61 U/dL (2–4,228). Mean removed nodes was 21 pelvic nodes (9–56, involved nodes 12.3%) and 19 para-aortic nodes (7–51, involved nodes 14.8%). A laparoscopic approach was performed in 65% patients. Mean follow-up was 46 months. The factors that impact on survival were compared using univariate and multivariate analysis.
Results The estimated 5-year DFS and OS comparated rates were respectively, according to FIGO local stages (I) 93.9 and 90.2%, vs advanced stages (II–IV) 0 and 53.7% (p=0.00 Hazard ratio 5.58 (CI 95%, 2.74–11.35) and p=0.00 Hazard ratio 4.19 (CI 95%, 2.11–8.34); obesity BMI <30 84 and 85.5%, vs BMI >30 82.7 and 80.8 (p=0.61 and p=0.38); preoperative Ca125 levels <35 U/dL 86.6 and 88.6%, vs Ca125 level <35 86.6 and 88.6% (p=0.17 and p=0.02 Hazard ratio 2.67 (CI 95%, 1.09–6.51); laparoscopic surgical approach 86.5 and 88.7%, vs laparotomy 58 and 75.4% (p=0.77 and p=0.27); complete surgical surgery 92 and 92%, vs incomplete 0 and 27.3% (p=0.00 Hazard ratio 3.64 (CI 95%, 1.48–8.39) and p=0.00 Hazard ratio 7.03 (CI 95%, 3.04–16.25); without lymphadenectomy 86.9 and 86.8%, vs performed lymfadenectomy 91.4 and 75.8% (p=0.01 Hazard ratio 2.94 (CI 95%, 1.21–7.16) and p=0.33); negative lymph involvement 81.9 and 85.9%, vs involved nodes 0 and 60% (p=0.00 Hazard ratio 3.17 (1.41–7.11) and p=0.01 Hazard ratio 3.22 (CI 95%, 1.2–8.62).
Conclusion DFS and OS increased in case of complete debulking, low Ca12.5 leves prior to surgery, the abscence of lymph involvement and patients who underwent lymphadenectomy.
Disclosure Nothing to disclose.
Results of univariante Cox analysis of Overall survival (OS): (A) FIGO stages. (B) Surgical approach
Overall survival (OS) by miometrial invasion. Disease-Free Survival (DFS) for lymph node involvement