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Optimizing patient selection for secondary cytoreductive surgery in recurrent endometrial cancer
  1. Virginia Vargiu1,
  2. Andrea Rosati1,2,
  3. Lucia Tortorella1,
  4. Diana Giannarelli3,
  5. Vito Andrea Capozzi4,
  6. Valerio Gallotta1,
  7. Alessandro Gioè1,
  8. Ettore Di Stefano2,
  9. Martina Corrado2,
  10. Roberto Berretta4,
  11. Francesco Cosentino5,
  12. Giovanni Scambia1,2 and
  13. Francesco Fanfani1,2
    1. 1Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
    2. 2Università Cattolica del Sacro Cuore, Rome, Italy
    3. 3Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
    4. 4Department of Medicine and Surgery, University of Parma, Parma, Italy
    5. 5Department of Medicine and Health Sciences "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
    1. Correspondence to Dr Francesco Fanfani, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Lazio, Italy; francesco.fanfani74{at}policlinicogemelli.it

    Abstract

    Objective This retrospective, multicenter, observational study aimed to refine patient selection criteria for secondary cytoreductive surgery in recurrent endometrial cancer. The objective was to identify preoperative predictors of complete cytoreduction, assess surgical complexity, and propose a preoperative predictive scoring system to identify suitable candidates for secondary cytoreductive surgery.

    Methods Data from 331 women with recurrent endometrial cancer were analyzed across three Italian centers from January 2010 to December 2021. Patients were categorized based on treatment received (medical treatment, diagnostic laparoscopy/examination under anesthesia, or secondary cytoreductive surgery). Preoperative predictors, surgical complexity, complications, and a predictive scoring system were assessed. Logistic regression and receiver operating characteristic analysis were used for statistical evaluation.

    Results Of the cohort, 56.2% underwent debulking surgery, 17.2% had diagnostic laparoscopy, and 26.6% received medical treatment. Patients undergoing secondary cytoreductive surgery were younger, with a lower body mass index, better performance status, and fewer comorbidities. Single site locoregional relapse was common in secondary cytoreductive surgery patients. Age <65 years, single site relapse, lymph node, and hematogenous relapse were independent predictors of complete cytoreduction. A predictive scoring system demonstrated a clear relationship between the score and the likelihood of complete cytoreduction.

    Conclusion This study identified age <65 years, single site recurrence, as well as nodal and hematogenous recurrence, as predictive factors for achieving optimal cytoreduction. A predictive scoring system incorporating these factors has been proposed to identify optimal candidates for secondary cytoreductive surgery in recurrent endometrial cancer. The scoring system showed promising predictive accuracy and could aid in refining the decision making process, ensuring appropriate patient selection for secondary cytoreductive surgery. Further prospective studies are warranted to validate and enhance the predictive model.

    • Endometrial Neoplasms
    • Neoplasm Recurrence, Local
    • Cytoreduction surgical procedures

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/ijgc-2024-005383

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • X @frafanfani

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

      • 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.