Factors associated with survival after relapse in patients with low-risk endometrial cancer treated with surgery alone

• Published in: Journal of gynecologic oncology Vol. 28; no. 5; pp. 1 - 14
• Main Authors: Nazli Topfedaisi Ozkan, Mehmet Mutlu Meydanlı, Mustafa Erkan Sarı, Fuat Demirkiran, Ilker Kahramanoglu, Tugan Bese, Macit Arvas, Hanifi Şahin, Ali Haberal, Husnu Celik, Gonca Coban, Tufan Oge, Omer Tarik Yalcin, Özgür Akbayır, Baki Erdem, Ceyhun Numanoğlu, Nejat Özgül, Gökhan Boyraz, Mehmet Coşkun Salman, Kunter Yüce, Murat Dede, Mufit Cemal Yenen, Salih Taşkın, Duygu Altın, Uğur Fırat Ortaç, Hülya Aydın Ayık, Tayup Şimşek, Tayfun Güngör, Kemal Güngördük, Muzaffer Sancı, Ali Ayhan
• Format: Journal Article
• Language: Korean
• Published: 대한부인종양학회 10-09-2017
• Subjects: Endometrial Neoplasms; Local Neoplasm Recurrence; Recurrence; Survival Analysis
• ISSN: 2005-0380

Objective: To determine factors influencing overall survival following recurrence (OSFR) in women with low-risk endometrial cancer (EC) treated with surgery alone.
Methods: A multicenter, retrospective department database review was performed to identify patients with recurrent “low-risk EC” (patients having less than 50% myometrial invasion [MMI] with grade 1 or 2 endometrioid EC) at 10 gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected.
Results: We identified 67 patients who developed recurrence of their EC after initially being diagnosed and treated for low-risk EC. For the entire study cohort, the median time to recurrence (TTR) was 23 months (95% confidence interval [CI]=11.5-34.5; standard error [SE]=5.8) and the median OSFR was 59 months (95% CI=12.7-105.2; SE=23.5). We observed 32 (47.8%) isolated vaginal recurrences, 6 (9%) nodal failures, 19 (28.4%) peritoneal failures, and 10 (14.9%) hematogenous disseminations. Overall, 45 relapses (67.2%) were loco-regional whereas 22 (32.8%) were extrapelvic. According to the Gynecologic Oncology Group (GOG) Trial-99, 7 (10.4%) out of 67 women with recurrent low-risk EC were qualified as high-intermediate risk (HIR). The 5-year OSFR rate was significantly higher for patients with TTR ≥36 months compared to those with TTR <36 months (74.3% compared to 33%, p=0.001). On multivariate analysis for OSFR, TTR <36 months (hazard ratio [HR]=8.46; 95% CI=1.65-43.36; p=0.010) and presence of HIR criteria (HR=4.62; 95% CI=1.69-12.58; p=0.003) were significant predictors.
Conclusion: Low-risk EC patients recurring earlier than 36 months and those carrying HIR criteria seem more likely to succumb to their tumors after recurrence.