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Original research
Major determinants of survival in recurrent endometrial cancer—the role of secondary cytoreductive surgery: a multicenter study
  1. Virginia Vargiu1,
  2. Andrea Rosati1,2,
  3. Vito Andrea Capozzi3,
  4. Alessandro Gioè1,
  5. Stefano Restaino4,
  6. Roberto Berretta3,
  7. Francesco Cosentino5,
  8. Giovanni Scambia1,2 and
  9. Francesco Fanfani1,2
  1. 1Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  2. 2Università Cattolica del Sacro Cuore, Roma, Lazio, Italy
  3. 3Department of Medicine and Surgery, University of Parma, Parma, Italy
  4. 4Obstetrics, Gynecology and Pediatrics Department, Udine University Hospital, DAME, Udine, Italy
  5. 5Department of Oncology, Gemelli Molise, Campobasso, Italy
  1. Correspondence to Dr Francesco Fanfani, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy; francesco.fanfani74{at}gmail.com

Abstract

Objective The main objective of the study was to assess the influence of different clinical and therapeutic variables on the oncological outcomes of patients with endometrial cancer relapse. In particular, we evaluated the impact of cytoreductive surgery with the achievement of complete gross resection.

Methods This is a multicenter retrospective cohort study conducted in three centers in Italy and including all patients with first relapse of endometrial cancer from January 2010 to December 2021.

Results Data from 331 women with recurrent endometrial cancer were analyzed. Secondary cytoreductive surgery was performed in 56.2% of cases (186 patients). Complete gross resection was achieved in 178 patients (95.7%). Complete gross resection conferred a statistically significant survival benefit both for post-relapse survival and post-relapse free survival (3 years post-relapse survival: 75.4% vs 56.4%, p<0.001; 3 years post-relapse free survival: 32.6% vs 26.5%, p=0.027). At multivariate Cox regression analysis, age ≥75 years, Eastern Cooperative Oncology Group Performance Status ≥2, the advanced-metastatic risk group, complete gross resection, and multiple site relapses were identified as independent significant predictors for post-relapse survival; regarding post-relapse free survival, only age ≥75, the high and advanced-metastatic risk groups, and complete gross resection confirmed their statistical significance.

Conclusions Secondary cytoreductive surgery with achievement of complete gross resection was confirmed to be an independent positive predictor for survival in patients with recurrent endometrial cancer and should be considered a valid primary treatment in the therapeutic decision-making process.

  • endometrial neoplasms
  • neoplasm recurrence, local
  • cytoreduction surgical procedures

Data availability statement

Data are available upon reasonale request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

https://doi.org/10.1136/ijgc-2023-004533

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    Data availability statement

    Data are available upon reasonale request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

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    Footnotes

    • Twitter @frafanfani

    • Contributors VV: conceptualization, data curation, formal analysis, methodology, writing - original draft. AR: conceptualization, data curation, formal analysis, methodology, writing - original draft. VAC: data curation, methodology. AG: data curation. SR: data curation. RB: writing - review and editing, supervision. FC: writing - review and editing, supervision, validation. GS: project administration, supervision, validation. FF: project administration, writing - review and editing, supervision, validation, 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.