Introduction/Background Literature evidence showed that patients with endometrial cancer (EC) recurrence benefiting from secondary cytoreductive surgery (SCS) had significantly better survival outcomes than patients not undergoing SCS, however, only a minority is considered eligible (13–38%).In this study, we retrospectively analyzed clinical-histological variables that could predict patient operability.
Methodology Multicenter, retrospective analysis including patients with EC recurrences diagnosed through radiological and/or histological examination between January-2010 and December-2021.
Results Three-hundred-thirty-one patients have been retrieved. One-hundred-eighty-six patients underwent SCS (Group-1), while 145 were addressed to other secondary treatment (chemotherapy ± radiotherapy ± palliative care) (Group-2).Patients selected for SCS were statistically younger, with lower body mass index (BMI), better Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) and with less comorbidities (Group 1 vs 2: age≥75: 9.7% vs 20.0 p<0.001, BMI≥30: 30.6% vs 44.1%, p=0.016, ECOG-PS≥2: 19.8% vs 30.3%, p<0.001, Aged-Adjusted Charlson Comorbidity Index, AACCI>2: 67.7% vs 86.2%, p<0.001) (Table-1).At univariate analysis age≥75, BMI≥30, ECOG-PS≥2, AACCI>2, augmented Ca-125, evidence of multiple-site metastasis and of a mixed pathway of recurrence were statistically significant factors for a reduced probability of undergoing SCS. At multivariate analysis only ECOG-PS≥2 (OR: 0.370, p=0.024), augmented Ca-125 (OR:0.482, p=0.042), multiple-site metastasis (OR: 0.429, p=0.024) and the mixed recurrence pathway (OR: 0.111, l=0.008) confirmed to be negative predictors. Conversely, nodal recurrence-pathway showed an OR of 2.173, p=0.042 suggesting a higher chance to undergo SCS (Table-1).Complete gross resection (CGR) was achieved in the 95.7% of patients selected for surgery (table 1).
Conclusion Age>75 years, ECOG-PS≥2, positive Ca-125, evidence of multiple-site relapse, and the mixed pathway of relapse are independent negative predictors of patient operability, while the nodal pathway of relapse has been shown to be a positive predictor.Considering the CGR rate obtained in the selected population, these factors could be used to build a preoperative score to correctly identify patients who may benefit from SCS.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.