Introduction/Background*Histopathologic type, grading, myometrial invasion, lymphovascular space invasion (LVSI) and immunohistochemistry (POLEmt: POLE mutated; MMRd: mismatch repair deficient, p53abn: p53+) represent the main pathologic features to define the prognostic risk groups in endometrial cancer. This study aimed to evaluate the correlation between the prognostic factors and the rate of recurrence in our experience.
Methodology We conducted a monocentric retrospective study of consecutive women who underwent surgical treatment for endometrial cancer at Department of Gynecology Oncology, Treviso Regional Hospital, between January-2017 to October-2020. Baseline demographics, histopathologic type, grading, FIGO stage, LVSI, myometrial infiltration, lymph node involvement (LNI), and immunohistochemistry (when available) were collected. The diagnosis of recurrence and his pattern (distant or pelvic) were analyzed on the basis of prognostic factors type.
Result(s)*A total of 146 women were included: 105 patients in stage I (72%), 15 in stage II (10%), 22 in stage III (15%) and 4 in stage IV (3%). The rate of recurrence was 13% (19 patients) with a median time to recurrence of 15 months (3-42). A univariate approach showed a significantly association between recurrence and histopathologic non-endometrioid type (O.R 3.13; p=0.05), LNI (O.R 4.05; p=0.03), myometrial infiltration (O.R. 2.84; p=0.04), positive-LVSI (O.R. 3.32; p=0.01), grading (O.R. 3.9; p=0,0001), FIGO-stage (II O.R. 1.64; III O.R. 2.91; IV O.R. 10.20; p=0.03), and p53abn (O.R. 5.10; p=0.02). We found no significant differences between recurrence and MMRd (O.R. 0.90; p:0,8), no POLEmt was found in our recurrence patients. A positive-LVSI related with a distant recurrence (O.R 8.00; p=0.003). In multivariate analysis, FIGO stage and p53abn (OR=1.1 and OR=5.3; p-value=0.05, respectively) were found independent predictors factor for recurrence. In particular, all patients with p53abn and recurrence were in FIGO stage I at the diagnosis.
Conclusion*All prognostic factors related to recurrence, and FIGO-stage represented the most significant risk factor. Instead, when we considered immunohistochemistry, p53abn resulted in a negative prognostic factor for recurrence, independent to FIGO-stage. Positive-LVSI presented an important correlation with distant recurrence compared to women with negative-LVSI and only pelvic recurrences. Risk factors are important to define prognostic risk groups and adjuvant therapy.
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