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