Risk factors predicting recurrence in operated endometrial cancer.

Abstract

e15592 Background: Early stage endometrial cancers have a good prognosis. However, these are a heterogeneous group of patients with varying recurrence risk (RR). Methods: Retrospective analysis of patients, diagnosed and treated, with endometrial cancer at Flinders Medical Centre, South Australia, from 1 January 2000 until 31 December 2009. Demographic, clinical and pathologic factors were analyzed to determine association with RR. Results: A total of 152 women with a median age of 65 years were analysed. Surgery was the primary intervention in 146 patietns (96%). Optimal debulking status was achieved in 113 patients (74.3%). Endometriod adenocarcinoma was the most common histological subtype (67%). Other subtypes included adenocarcinoma (18.4%), papillary serous carcinoma (3.9%), carcinosarcoma (1.9%), mixed (4.6%) and other (3.9%). Fifty-eight patients had grade 1 tumour, 55 grade II and 36 grade III. Out of 103 patients who had their lymphovascular space invasion (LVSI) status assessed, 21 (20.4%) were positive while 82 (79.6%) were negative. Stages I, II, III & IV were constituted by 109, 10, 20 and 7 patients respectively. The numbers of patients with low, intermediate and high RR (as per stage and grade) were 114, 11 and 25 respectively. Forty-five patients (29.6%) received adjuvant treatment, which included external beam radiotherapy (26), brachy-therapy (10), chemotherapy (9) and medroxy-progesterone (2). At a median follow up of 33.6 months, 21 patients had evidence of disease recurrence. Recurrence was loco-regional in 11 patients and systemic in 10. On uni-variate Cox regression analysis, factors associated with increased RR included resection status, grade, LVSI, number of lymph nodes resected and risk category. LVSI status and risk category maintained their significance, as independent predictors of RR, in a multivariate model, when adjusted for age and adjuvant therapy. Adjuvant therapy did not seem to alter the RR. Conclusions: Our data confirmed the validity of risk stratification to assess the RR in operated endometrial cancer. Positive LVSI status also conferred an increased risk for recurrence. Further studies are required to determine the optimal role of adjuvant therapy, according to RR, in women with endometrial cancer.