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Original research
Recurrence rates and patterns of recurrence in stage IA p53abn endometrial cancer with and without myometrial invasion
  1. Amy Jamieson1,
  2. Marcel Grube2,
  3. Samuel Leung3,
  4. Derek Chiu3,
  5. Amy Lum3,
  6. Janice S Kwon1,
  7. Aline Talhouk1,
  8. Blake Gilks4,
  9. Stefan Kommoss2 and
  10. Jessica N McAlpine1
    1. 1Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, The University of British Columbia and BC Cancer, Vancouver, British Columbia, Canada
    2. 2Department of Women’s Health, Tübingen University Hospital, Tübingen, Germany
    3. 3Department of Molecular Oncology, University of British Columbia, Vancouver, British Columbia, Canada
    4. 4Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    1. Correspondence to Dr Amy Jamieson, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, The University of British Columbia, Vancouver, Canada; amy.jamieson{at}vch.ca

    Abstract

    Objectives Optimal management of patients with stage IA p53abn endometrial cancer without myoinvasion, classified as intermediate risk in the 2020 European Society of Gynaecological Oncology, European Society for Radiotherapy and Oncology, and European Society of Pathology (ESGO-ESTRO-ESP) guidelines, and the 2022 European Society of Medical Oncology (ESMO) guidelines, is currently unclear. Practice varies from surgery alone to adjuvant radiation±chemotherapy. Our aim was to assess the risk of disease recurrence in patients with stage IA p53abn endometrial cancer without myoinvasion compared with stage IA with myoinvasion (<50%).

    Methods Stage IA p53abn endometrial cancers were identified from retrospective cohorts. Cases were segregated into stage IA with no myoinvasion, including (1) tumor restricted to a polyp, (2) residual endometrial tumor, and (3) no residual tumor in hysterectomy specimen, versus stage IA p53abn with myoinvasion (<50%), with treatment and outcomes assessed.

    Results There were 65 stage IA p53abn endometrial cancers with no myoinvasion (22 polyp confined, 38 residual endometrial tumor, 2 no residual in hysterectomy specimen, 3 not specified) and 97 with myoinvasion. There was no difference in survival outcomes in patients with stage IA without myoinvasion (16% of patients recurred, 19% if there was residual endometrial disease) compared with stage IA with myoinvasion (17%). The risk of recurrence was lowest in patients with stage IA p53abn endometrial cancer without myoinvasion treated with chemotherapy±radiation (8%). Most recurrences in patients with stage IA without myoinvasion were distant (89%), with no isolated vaginal vault recurrences, and all except one distant recurrence occurred in patients who had not received adjuvant chemotherapy.

    Conclusion The recurrence rate in patients with stage IA p53abn endometrial cancer without myoinvasion was 16%, highest in the setting of residual endometrial disease (19%), and exceeding the threshold where adjuvant therapy is often considered. The high frequency of distant recurrences observed may support chemotherapy as part of the treatment regimen.

    • endometrium
    • uterine cancer

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/ijgc-2023-005149

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • Twitter @DrAmyJamieson

      • Contributors AJ, JNM and JSK conceptualized the study and provided cases. AT, SK and MG also contributed cases. AL and CBG performed the molecular classification. SL and DC analyzed the data. AJ drafted the manuscript, and all authors were involved with editing the final manuscript. AJ and JNM accept responsibility for the overall content/data.

      • Funding This work was supported by the Canadian Cancer Society Aggressive Uterine Cancer Grant, the Canadian Institute for Health Research, the Terry Fox Research Institute, the BC Cancer Foundation (a grateful patient from Victoria and the Clinician Scientist Award (JMc)), the Vancouver General Hospital Foundation, the Vancouver Coastal Health Research Institute (AJ), the Canada Research Chair Program and Chew Wei Memorial Chair in Gynecologic Oncology (JMc), and the Miller-Mindell Fellowship (AJ).

      • 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.