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Stratified follow-up for endometrial cancer: a move to more personalized cancer care
  1. Asma Sarwar1,2,
  2. Jennifer Van Griethuysen1,
  3. Jasmine Waterhouse1,
  4. Hakim-Moulay Dehbi2,
  5. Gemma Eminowicz1,2 and
  6. Mary McCormack1,2
  1. 1University College London Hospitals NHS Foundation Trust, London, UK
  2. 2University College London, London, UK
  1. Correspondence to Dr Asma Sarwar, 250 Euston Road, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK; asmasarwar{at}nhs.net

Abstract

Objective Hospital based follow-up has been the standard of care for endometrial cancer. Patient initiated follow-up is a useful adjunct for lower risk cancers. The purpose of this study was to evaluate outcomes of endometrial cancer patients after stratification into risk groupings, with particular attention to salvageable relapses.

Methods All patients treated surgically for International Federation of Gynecology and Obstetrics (FIGO) stage I–IVA endometrial cancer of all histological subtypes, from January 2009 until March 2019, were analyzed. Patient and tumor characteristics, treatment details, relapse, death, and last follow-up dates were collected. Site of relapse, presence of symptoms, and whether relapses were salvageable were also identified. The European Society of Medical Oncology–European Society of Gynecological Oncology 2020 risk stratification was assigned, and relapse free and overall survival were estimated.

Results 900 patients met the eligibility criteria. Median age was 66 years (range 28–96) and follow-up duration was 35 months (interquartile range 19–57). In total, 16% (n=144) of patients relapsed, 1.3% (n=12) from the low risk group, 3.9% (n=35) from the intermediate risk group, 2.2% (n=20) from the high–intermediate risk group, and 8.7% (n=77) from the high risk group. Salvageable relapses were less frequent at 2% (n=18), of which 33% (n=6) were from the low risk group, 22% (n=4) from the intermediate risk group, 11% (n=2) from the high–intermediate risk group, and 33% (n=6) from the high risk group. There were only three asymptomatic relapses in the low risk patients, accounting for 0.33% of the entire cohort.

Conclusions Relapses were infrequent and most presented with symptoms; prognosis after relapse remains favorable. Overall salvageable relapses were infrequent and cannot justify intensive hospital based follow-up. Use of patient initiated follow-up is therefore appropriate, as per the British Gynaecological Cancer Society's guidelines, for all risk groupings.

  • uterine cancer
  • radiotherapy

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. Deidentified participant data.

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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. Deidentified participant data.

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Footnotes

  • Contributors AS and MMC conceived and planned the presented work. Data collection was carried out by AS, JV, and JW. Data analysis and interpretation was performed by AS, JV, JW, MMC, GE, and H-MD. The article was drafted by AS and JV. Critical revision of the article was performed by MMC and GE. Final approval of the manuscript for publication was by AS, JV, JW, MMC, GE, and H-MD. MMC acting as guarantor.

  • 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.

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

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