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Clinical outcome of recurrent endometrial cancer: analysis of post-relapse survival by pattern of recurrence and secondary treatment
  1. Francesco Legge1,
  2. Stefano Restaino2,
  3. Luca Leone1,
  4. Vito Carone1,
  5. Carlo Ronsini3,
  6. Giacomo Lorenzo Maria Di Fiore2,
  7. Tina Pasciuto4,
  8. Silvia Pelligra3,
  9. Francesca Ciccarone2,
  10. Giovanni Scambia2,5 and
  11. Francesco Fanfani2,5
  1. 1Gynecologic Oncology Unit, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
  2. 2Dipartimento per la Tutela della Salute della Donna e della Vita Nascente, UOC di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
  3. 3Gynecologic and Obstetrics Unit, Università “G. d’Annunzio, Chieti, Italy
  4. 4Statistics Technology Archiving Research (STAR) Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
  5. 5Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
  1. Correspondence to Dr Francesco Fanfani, Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy; francesco.fanfani74{at}


Introduction Recurrence of endometrial cancer is an important clinical challenge, with median survival rarely exceeding 12 months. The aim of this study was to analyze patterns of endometrial cancer recurrence and associations of these patterns with clinical outcome.

Methods The study included patients with endometrial cancer who underwent primary surgical treatment with or without adjuvant treatment between July 2004 and June 2017 at the Gynaecologic Oncology Unit of one of three tertiary hospitals of the Catholic University Network in Italy with complete follow-up data available. Information on the date and pattern of recurrence was retrieved for each relapse. Post-relapse survival was recorded as the time from the date of recurrence to the date of death or last follow-up. Survival probabilities were compared using log rank tests, and associations of clinico-pathological characteristics with post-relapse survival were tested using Cox’s regression models.

Results A total of 1503 patients were included in the analysis. We identified 210 recurrences (14.0%) and 105 deaths (7.0%) at a median follow-up of 34 months (range 1–162). One hundred and fifty-eight recurrences (78.1%) occurred during the first two years of follow-up. Most recurrences were multifocal (n=121, 57.6%) and involved extrapelvic sites (n=38, 65.7%). Parameters associated with post-relapse survival in the univariate analysis included histotype, grade, time to recurrence, pattern of recurrence, number of relapsing lesions, and secondary radical surgery. Only the pattern of recurrence and secondary radical surgery were independent predictors of post-relapse survival in the multivariate analysis (p=0.025 and p=0.0001, respectively).

Conclusion Lymph node recurrence and the feasibility of secondary radical surgery were independent predictors of post-relapse survival in patients with recurrent endometrial cancer.

  • uterine neoplasms
  • endometrial neoplasms

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  • Contributors All authors have provided a substantial contribution to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institutional Review Board of each participating center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.