Endometrioid uterine cancer: Histopathological risk factors of local and distant recurrence

doi:10.1016/j.ygyno.2008.10.019

Gynecologic Oncology

Volume 112, Issue 2, February 2009, Pages 342-347

https://doi.org/10.1016/j.ygyno.2008.10.019 Get rights and content

Abstract

Objectives

To determine the relationship between histopathological prognostic factors and sites of initial recurrence in endometrioid uterine cancer.

Methods

A total of 355 patients (Stage I, n = 227; II, n = 38; III, n = 90) underwent primary radical surgery including complete systematic pelvic lymph node (PLN) and para-aortic lymph node (PALN) adenectomy followed by adjuvant chemotherapy who were at risk for recurrence. Relapse-free survival (RFS) and disease-related survival (DRS) were analyzed using the log-rank testing. Multivariate Cox regression analysis and logistic regression analysis were used to determine and estimate independent prognostic factors.

Results

Lymph-vascular space invasion (LVSI), architectural grade (AG), myometrial invasion, and PLN metastasis (PLNM) were identified as independent prognostic factors for RFS. AG (p = 0.0043) related with local recurrence. Among patients who received adjuvant chemotherapy, patients with G3 tumor had higher ratio of recurrence (16/45) compared with G1/2 tumor (11/102) (p = 0.0004). Meanwhile, PLNM related with distant recurrence (p = 0.0008). There was a statistically significant difference in RFS according to the number of positive PLN sites (group 0: n = 313, 1: n = 16, ≥ 2: n = 26), five-year RFS in each group was 91.9%, 81.3%, and 41.2%, respectively.

Conclusions

Sites of initial recurrence were related with AG and PLNM in patients with endometrioid uterine cancer. Current chemotherapy alone may not be an effective adjuvant therapy to prevent recurrence in patients with G3 tumor and ≥ 2 positive PLN sites. Prospective clinical trial needs to be conducted to establish the strategy of adjuvant therapy with these patients.

Introduction

Recurrences occur in all stages of initial disease in endometrial cancer and are uniformly associated with poor survival [1]. At present, there are adequate information in the literature on sites of recurrence in endometrial cancer [2], [3], [4], [5], [6], [7], [8]. In all of these reports, patients who were considered to be at risk for recurrence received adjuvant radiotherapy. Moreover, to the best of our knowledge, the literature on risk for recurrence in patients with endometrial cancer who undergo both pelvic lymph node (PLN) and para-aortic lymph node (PALN) adenectomy and receive adjuvant chemotherapy appears to be lacking.

The aim of this study was to determine relationships between histopathological prognostic factors and sites of initial recurrence in patients with endometrial cancer who underwent systematic complete PLN and PALN adenectomy and received adjuvant chemotherapy who were considered to be at risk for recurrence.

Section snippets

Materials and methods

A total of 956 patients with endometrial carcinoma had primary surgery treatment in the Tohoku Gynecologic Cancer Unit, involving 6 Universities and affiliated hospitals, between 1993 and 2004. Type II endometrial cancers (clear cell/serous adenocarcinoma) were excluded from this analysis. Also patients receiving pre-/post-operative radiation or neoadjuvant chemotherapy, and stage IV patients were excluded. Among them, 355 patients underwent primary radical surgical treatment, that is, modified

Uni- and multivariate survival analysis for all patients

Patient characteristics are shown in Table 1. Median age was 54 years (range, 27–76 years). Five-year RFS and DRS in each stage were: stage I, 95.5% and 98.0%; stage II, 88.3% and 94.1%; and stage III, 67.8% and 71.2%, respectively. Among stage III patients, 25 patients had only positive peritoneal cytology without invasion of the outer half of the myometrium, cervical stromal invasion, ovarian metastasis, and lymph node metastasis. These patients did not receive adjuvant chemotherapy.

Discussion

Radiotherapy and chemotherapy are used as adjuvant therapies for endometrial carcinoma. Previous randomized studies [13], [14], [15] have shown that, while postoperative radiotherapy decreases the risk of locoregional recurrence, but it does not improve the overall survival rate. The Gynecologic Oncology Group (GOG) 122 clearly showed that adjuvant chemotherapy significantly improved progression-free and overall survival compared to adjuvant radiotherapy (whole abdominal radiotherapy) for Stage

Conflict of interest statement

The authors declare that there are no conflicts of interest.

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Endometrioid uterine cancer: Histopathological risk factors of local and distant recurrence

Abstract

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Uni- and multivariate survival analysis for all patients

Discussion

Conflict of interest statement

Radiother. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

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Int. J. Radiat. Oncol. Biol. Phys.

Int. J. Radiat. Oncol. Biol. Phys.

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Int. J. Radiat. Oncol. Biol. Phys.

Int. J. Radiat. Oncol. Biol. Phys.