Introduction/Background Despite the good prognosis of early-stage endometrial cancer and the recent advances in terms of risk stratification and treatment, recurrence remains a significant clinical challenge. Aim of this study is to assess the impact of histological and molecular characteristics on recurrence pattern of endometrial cancer.

Methodology This study retrospectively evaluated 415 patients with endometrial cancer who underwent primary surgical treatment between 2009 and 2022 at the Academic Division of Gynecology, Mauriziano Hospital, Torino, Italy. Among them, 34 molecularly classified recurrences were observed. All variables were analyzed using Fisher's exact test for categorical variables and t-test for continuous variables. Univariate and multivariate analysis were performed to assess the relationship between molecular characteristics and pattern of recurrence.

Results Abnormal p53 endometrial cancers showed more peritoneal recurrences at univariate and multivariate analysis (p=0.002; OR=18.2; CI: 3.006–111.18). Moreover, peritoneal recurrences in abnormal p53 tumors had shorter recurrence-free survival than in the wild-type p53 group (median 12.66 vs. 21.65 months, Logrank, p<0.001). A trend toward a higher prevalence of positive peritoneal cytology at onset (p=0.085) and high-grade disease (p=0.092) was observed in tumors with diffuse peritoneal recurrence. However, no correlations were detected in other recurrence sites (lung, liver, bone and lymph nodes) for the examined variables.

Conclusion This investigation revealed a correlation between molecular classification and pattern of recurrence in endometrial cancer patients. p53abn patients experienced abdominal relapse more often and earlier than wild-type ones. Future prospective studies are needed to confirm these assumptions in order to enable clinicians to build an increasingly tailored follow-up pathway.

Disclosures The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

No specific funding was obtained for this study.