Stage Endometrial Cancer Research Articles

Multiparametric magnetic resonance imaging facilitates the selection of patients prior to fertility-sparing management of endometrial cancer.

To compare the diagnostic performance of biparametric magnetic resonance imaging (bpMRI) versus multiparametric MRI (mpMRI) for the staging of well-differentiated endometrioid endometrial cancer (EC) in potential candidates for fertility-sparing management. This multi-center retrospective study included 48 potential candidates for fertility-sparing management (age <46 years, grade 1 endometroid EC) who did not wish to undergo fertility-sparing management and thus underwent definitive surgery. Two readers (R1, R2) independently reviewed bpMRI (T1, T2, and diffusion-weighted imaging) and mpMRI (bpMRI and dynamic contrast-enhanced imaging, DCE) during two separate sessions spaced one month apart for the presence of myometrial invasion (MI), cervical stromal involvement (CSI), malignant adnexal disease (mAD), and pelvic lymphadenopathy (pLNM). Each reader also recorded maximum tumor diameter, tumor volume, and tumor-to-uterine volume ratio (TVR) on T2-weighted imaging. The diagnostic performance of bpMRI and mpMRI was determined for each reader with surgical pathology serving as a gold standard. The area under the receiver operating curve (AUC) for bpMRI versus mpMRI was 0.76/0.78 (R1/R2) versus 0.84/0.83 for MI, 0.79/0.76 versus 0.99/0.80 for CSI, 0.84/0.84 versus 0.84/0.80 for mAD, and 0.82/0.82 for pLMN. The sensitivity and specificity of MRI for detecting tumor spread beyond the endometrium were 71%/77% and 71%/65% for bpMRI (R1/R2) vs. 84%/90% and 71%/65% for mpMRI (R1/R2), respectively. The AUC of maximum tumor diameter, tumor volume, and TVR for MI was 0.71/0.61, 0.73/0.75, and 0.75/0.77 for R1/R2, respectively. MRI had moderate diagnostic performance across potential candidates for fertility-sparing treatment of EC. mpMRI outperformed bpMRI for detecting EC spreading beyond the endometrium.

Is Peritoneal Cytology an Independent Prognostic Factor in Early-Stage Endometrial Cancer?

The prognostic significance of positive peritoneal cytology (PPC) in patients with early-stage endometrial cancer (Stage I/II) was disregarded by FIGO in 2009 classification, though FIGO recommends to collect peritoneal washings for cytology in all patients of endometrial carcinoma. To find out the association between positive peritoneal cytology and other prognostic factors of early-stage endometrial cancer and the influence of positive peritoneal cytology on survival of these patients. Primary objective—Association of positive peritoneal cytology with overall survival (OS) and disease-free survival (DFS). Secondary objective—Association of positive peritoneal cytology with other prognostic factors of early-stage endometrial cancer. Data were collected retrospectively from department of Gynecological oncology, Acharya Harihar Regional Cancer Center, Cuttack, India, between July 2009 and December 2017. Patients with stage I/II endometrial cancer who had undergone complete surgical staging procedure including pelvic lymphadenectomy were included. Comparison of pathological characteristics in patients with or without malignant cells in peritoneal cytology was done using univariate and multivariate analysis followed by survival analysis using Kaplan–Meier curves in these two groups, and the difference in survival was obtained by the log-rank test. Out of total 192 patients, 29 (15.1%) had positive peritoneal cytology. Among patients with positive peritoneal cytology, 27.6% patients had non-endometrioid histology like clear cell carcinoma and serous carcinoma of endometrium (P = 0.001). Similarly, 44.8% patients had Grade 3 histology, 51.7% patients had more than 50% myoinvasion, 48.3% patients had positive LVSI (lymphovascular space invasion) and 17.2% patients had stage II disease. Patients with positive peritoneal cytology had 17 months of lower disease-free survival (P < 0.0001) and 16 months of lower overall survival (P < 0.0004) compared to patients with negative peritoneal cytology. In multivariate analysis, positive peritoneal fluid cytology remained an independent prognostic factor for both disease-free survival (DFS) and overall survival (OS). Our study suggests that positive peritoneal cytology may be a potential prognostic factor in early-stage endometrial cancer owing to its significant association with other prognostic factors and its significant influence on both DFS (disease-free survival) and OS (overall survival).

From systematic lymphadenectomy to sentinel lymph node mapping: a review on transitions and current practices in endometrial cancer staging.

Endometrial cancer care has undergone major changes in the past 30 years. In 1988, staging transitioned from clinical to surgical. Moreover, the surgical approach of choice is no longer open surgery, but minimally invasive surgery. An improvement in terms of nodal evaluation followed. Full systematic lymphadenectomy has been continuously replaced by sentinel lymph node mapping. Although sentinel lymph node mapping with a cervical injection of indocyanine green dye is rapidly gaining clinical acceptance, we lack consistent recommendations on a well-defined procedure that accurately and indolently assesses the lymph node status. Such recommendations are indispensable, as nodal status is the most important predictive factor of survival and is essential for tailoring adjuvant treatment to the risk of recurrence. This paper focuses on transitions in endometrial cancer care and highlights current data on sentinel lymph node mapping in endometrial cancer. We demonstrate that sentinel lymph node mapping is a safe and accurate strategy for nodal status evaluation with appropriate sensitivity, false-negative rate and negative predictive value in high- as well as low-risk settings. Furthermore, we elaborate on type and dose of tracer, site of injection, number of sentinel lymph nodes to be removed, sentinel lymph node mapping learning curve, operation mode and sentinel lymph node ultrastaging. In the future, guidelines with consistent recommendations on the above outlined features of sentinel lymph node mapping should be established to allow for a uniform and wide-spread application of the sentinel lymph node mapping procedure.

Clinical Impact of Preoperative Magnetic Resonance Imaging in the Evaluation of Myometrial Infiltration and Lymph-Node Metastases in Stage I Endometrial Cancer.

: Purpose: In the developed world, endometrial cancer is one of the most common malignant gynecological cancer types. Due to the highly available diagnostic modalities and patient education, the early detection of the tumor leads to high overall survival. Methods: In this study we analyzed the reliability of preoperative MRI findings in the staging of early stage endometrial cancer, as well as the clinical characteristics of patients underwent radical hysterectomy and the histopathologic evaluation of their tumor, with the retrospective data of radical hysterectomies performed in our hospital between 2010 and 2019. Results: The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI regarding stage were 94.7, 63.3, 94.8, 83.8, and 83.8%, respectively. The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI for the detection of the myometrial invasion were 69.8, 80.0, 60.8, 64.3, and 77.5%, respectively. The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI for the detection of lymph node metastases were 78.1, 28.6, 82, 11.1, and 93.6%, respectively. Conclusions: Based on our results, MRI is the method of choice in terms of evaluating overall staging, as well as myometrial invasion, as its specificity and negative predictive value are relatively high. However, systematic lymphadenectomy showed improved cancer-related survival and recurrence-free survival. Our studies showed that the diagnosis of lymph node metastases is difficult with MRI modality since hyperplastic and metastatic nodes cannot easily differentiate, leading to a high percentage of false-positive results. Therefore, other imaging modalities may be used for more accurate evaluation. New findings of our study were that the role of the radiologist’s expertise in the evaluation of MR imaging plays an essential role in lowering false-negative and false-positive results. Therefore, findings evaluated by a radiologist with high-level expertise in gynecological imaging can complement the clinical findings and help substantially define the needed treatment.

Can the Determination of HE4 and CA125 Markers Affect the Treatment of Patients with Endometrial Cancer?

The aim of our research was to determine the use of CA125 and HE4 as prognostic factors in patients with different clinical staging of endometrial cancer. Sixty-two patients with advanced endometrial cancer and 287 patients with early stage endometrial cancer participated in the study. Based on the results obtained in the study, the cut-off value for HE4 was established at 186 pmol/l and correlated with the possibility of cytoreductive surgery in patients with recurrent endometrial cancer. Univariate logistic regression revealed that serum concentrations for the median CA125 correlated with DFS (HR = 1.76, p = 0.033) and OS (HR = 1.42, p = 0.025), while the median of HE4 marker correlated with DFS (HR = 1.96, p = 0.015) and OS (HR = 1.83, p = 0.004). In the multivariate analysis, a decrease in CA125 level below normal range correlated positively with DFS and OS (HR = 1.45, p = 0.026; HR = 1.38, p = 0.037). HE4 levels correlated with DFS as follows: values below the normal range (HR = 2.31, p = 0.01), and with OS (HR = 1.89, p = 0.004). Based on the results obtained in the study, we found that HE4 is a sensitive tool for predicting the risk of recurrence and overall survival in patients with endometrial cancer.

Evaluation of the Prognostic Value of Peritoneal Cytology in Patients with Endometrial Cancer: A Protocol for a Systematic Review and Meta-Analysis

Objective: In 1988, a new conception for endometrial cancer staging was introduced by Fédération Internationale de Gynecologie et d'Obstétrique (FIGO). In addition to pathologic development, peritoneal cytology played an important role in the staging. The goal of peritoneal cytology was to identify hidden and microscopic extensions outside the uterus. In 2009, the system was reviewed; one of the changes was removing the peritoneal cytology. The aim of this review is to evaluate the effect of peritoneal cytology on the survival of patients with endometrial cancer.&#x0D; Methods and analysis: This protocol is reported based on the PRISMA-P guideline. We will search "endometrial cancer," "peritoneal washing," and any other relevant words on PubMed, Cochran, EMBASE, and Scopus databases. The eligibility criteria are: All original studies performed on patients with endometrial cancer, evaluated survival, and performed peritoneal washing cytology. Only one of the non-English studies with the same respect will be included according to the research team's opinion. Also, the most recent paper among multiple articles about a single study is chosen. It should be noted that there will not be any restrictions regarding the language and publication date. For quality assessment, we will use the quality in prognosis (QUIPS) tool. If possible, a meta-analysis will also be performed using a rndom effects model, and overall survival rates and confidence intervals will be reported. Heterogeneity will be tested by using the I2 index and Cochrane's Q test. Subgroup analysis will be performed to handle the heterogeneity. The publication bias will be assessed in the presence of 10 or more relevant articles. If there is no chance of meta-analysis, the result will be reported qualitatively.&#x0D; Discussion: The resulting review will provide valuable information regarding the prognostic value of peritoneal cytology in patiens with endometrial cancer.

Perioperative outcomes of the first five cases of surgeries for endometrial endometrioid cancer using the new integrated table motion for da Vinci Xi®.

The aim of this study was to evaluate feasibility of integrated table motion (ITM), comparing perioperative outcomes of patients with diagnosed endometrial endometrioid cancer who underwent total robotic hysterectomies (TRHs) and case-related staging procedures with and without ITM. Five patients underwent surgery with da Vinci Xi system and ITM technology. ITM feasibility, efficacy and safety was compared with a second group of 56 patients, reduced to 10 with propensity score method, who underwent same procedures with da Vinci Xi System without ITM system. We report safety of robotic surgery with new ITM even in a preliminary experience of oncologic procedures. No significance in any analysed data between groups TRH with ITM and TRH without ITM are described. This preliminary study demonstrated the feasibility of ITM in performing da Vinci Xi TRH even in the first cases of surgery for malignancy such as early stage endometrial endometrioid cancer.

Blue dye single labelling for colorimetric sentinel lymph node mapping in early endometrial cancer: A feasibility study

BackgroundSurgical staging in endometrial cancer includes a systematic lymphadenectomy with significant morbidity, although its therapeutic role is unclear. Sentinel lymph node (SLN) study is a less morbid alternative to identify nodes most likely to be metastatic, permitting selective removal and thus reducing morbidity without compromising oncological safety. This study was done using blue dye single labelling to study the feasibility and utility in identifying SLN in early disease. MethodsTwenty-two patients of early-stage low-risk disease during surgical staging underwent cervical injection of methylene blue, SLN mapping, and sampling as per the standard algorithm, followed by a systematic lymphadenectomy in all cases. SLN were submitted separately for ultrastaging (US). ResultsTwenty patients underwent the procedure, and SLN could be identified in 18 patients with an overall mapping rate of 90% with a bilateral mapping rate of 70%, and a negative mapping rate of 10%. 57 SLN were identified along with two suspicious non-sentinel nodes and 11 were metastatic on US with a sensitivity of 66.7% and NPV of 87.5%. All patients with metastatic nodes, however, could be identified by applying the standard SLN algorithm for sampling. ConclusionSLN mapping algorithm with blue dye single labelling in early endometrial cancer, by identifying LN most likely to be metastatic enabling their selective removal may help avoid routine lymphadenectomies without compromising oncological safety. The procedure is simple and can be practiced at all centres and can also aid pathologists by pinpointing the likely metastatic nodes after a selective or complete lymphadenectomy.

The Prognostic Role of LRIG Proteins in Endometrial Cancer.

Simple SummaryOver the past few years, there have been many studies investigating the LRIG (leucine-rich repeats and immunoglobulin-like domains) family of transmembrane proteins, focusing mainly on their role in cancer progression. However, the prognostic role of the proteins in endometrial cancer was not studied, even though it is the most common gynecologic cancer in developed countries. Therefore, our research group aimed to fill this knowledge gap. Here, our study analyzed endometrial cancer tissue using immunohistochemistry. As a result, we found that one of the LRIG proteins—LRIG3—might influence endometrial cancer survival rates. However, the role of the LRIG1 and LRIG2 proteins in the group remains to be clarified. In conclusion, our study expands upon knowledge on the prognostic role of LRIG family in gynecological malignancies.Endometrial cancer (EC) is the most common gynecologic malignancy in Sweden and it has various prognostic factors. The LRIG family is a group of three integral surface proteins with a similar domain organization. The study aimed to explore LRIG family as prognostic factor proteins in EC. The initial study cohort included 100 women with EC who were treated at the Department of Women’s and Children’s Health, Karolinska University Hospital Solna, between 2007 and 2012. We assessed the associations between LRIG protein expression and type, grade, and stage of EC, as well as progression-free and overall survival. Immunohistochemistry results revealed that most women in the analytical sample had >50% LRIG1-, LRIG2- and LRIG3-positive cells. A statistically significant association was observed between having a high number of LRIG3-positive cells and superior overall survival (incidence rate ratio = 0.977; 95% confidence interval: 0.958–0.996, p = 0.019). Moreover, positive LRIG3 staining of the cell membrane was associated with reducing in the risk of death (hazard ratio = 0.23; 95% confidence interval: 0.09–0.57). Our results show that LRIG3 expression might be a prognostic factor in EC. The role of LRIG1 and LRIG2 expression remains to be further investigated.

Sentinel Lymph-Node Mapping with Near-Infrared Indocyanine Green in Laparotomy for Early Endometrial Cancer

Objective: Sentinel lymph-node (SLN) mapping with indocyanine green (ICG) and near-infrared (NIR) imaging is a feasible alternative to pelvic lymphadenectomy in endometrial cancer staging. While IC...

Development of a surgical competency assessment tool for sentinel lymph node dissection by minimally invasive surgery for endometrial cancer

IntroductionSentinel lymph node dissection is widely used in the staging of endometrial cancer. Variation in surgical techniques potentially impacts diagnostic accuracy and oncologic outcomes, and poses barriers to the comparison...

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Endometrial cancer is the most frequent gynecologic tumor in our setting. The majority of cases are diagnosed in women older than 50 years of age. Type 1 endometrial cancer is the most frequent. Hormonal factors, specifically prolonged exposure to estrogen, are the main risk factor for developing its precursor lesion, endometrial hyperplasia, and its later progression to adenocarcinoma. Abnormal uterine bleeding is the most common symptom and occurs in the majority of patients who are already in the early stages of endometrial cancer. Therefore, its presence must be ruled out in all cases of abnormal bleeding. The initial imaging test of choice is a transvaginal ultrasound. An endometrial biopsy is necessary for its histological confirmation. The main prognostic factor of endometrial cancer is postsurgical staging. Surgery is the fundamental pillar of the treatment of this pathology. Chemotherapy and radiotherapy play an important role as adjuvant treatment of high-risk, locally advanced tumors. In metastatic disease, treatment is mainly based on palliative chemotherapy, although in select patients, hormone therapy is a reasonable option.

Feasibility of in vitro maturation of oocytes collected from patients with malignant ovarian tumors undergoing fertility preservation

ObjectiveIn vitro maturation of oocytes collected from oophorectomy samples might be a promising approach in the field of oncofertility. In this study, we evaluate the feasibility of in vitro maturation...

Accuracy of intra-operative frozen section in guiding surgical staging of endometrial cancer.

Surgery consists the main treatment of endometrial cancer; however, decision of lypmhadenectomy is controversial. Intra-operative frozen section (FS) is commonly used in guiding surgical staging; nevertheless, there are different reports regarding its adequacy and reliability. Aim of this study is to assess accuracy of FS in predicting paraffin section (PS) results in patients with endometrium cancer. Data of 223 cases, who were operated for endometrial cancer at a tertiary hospital in 2012-2019, were analyzed retrospectively. Histological type, grade, tumor diameter, depth of myometrial invasion, and cervical and adnexal involvement in frozen and paraffin section were evaluated. Positive and negative predictive values and accuracy of frozen results in predicting paraffin results for each parameter was assessed. Statistical significance was taken as 0.05 in all tests. Accuracy of FS in predicting PS results were 76.23% for histology, 75.45% for grade, 85.31% for depth of myometrial invasion, and 95.45% for tumor diameter. Surgery, based on FS results, caused undertreatment in 4 patients, while metastatic lymph node ratios were found in only 35.3-50.0% of cases who had high risk parameters at FS. Our FS results have reasonable accuracy rates in predicting PS results, in comparison with the previous literature. However, even if the high risk parameters detected in FS predict PS accurately, absence of lymph node involvement in all cases with high risk parameters indicates that FS-based triage cannot prevent unnecessary lymphadenectomies.

Sentinel lymphadenectomy versus total lymphadenectomy in the staging of endometrial cancer

Surgical staging of endometrial cancer includes a hysterectomy, bilateral salpingo-oophorectomy, and evaluation of regional LN involvement, specifically the pelvic and aortic lymph node. Sentinel lymphadenectomy has been suggested in the staging process of the diseases. The aim of this study was to compare the role SLN mapping over total lymphadenectomy for detection of disease metastasis in cases of cancer of the endometrium Method: 30 patients that were diagnosed of having endometrial cancer . were included in this stud and were divided in to two equal groups and mapping was done to 15 patients and all patient had undergone lymphadenectomy Results: In this study The mean age of patients was 55 years ( range 45-74) for group 1 and was 56ys ( range 43-75) for group2. Also the increase in weight as BMI, Median (Range) was 35 (26-45) for group 1 and for group2 was 34 (28-50). The postoperative results had shown some changes as about ( 60%) of patients were of grade 1 and about (33.3%) of patients were of grade 2 and about ( of patients were of grade 3 this was for group1 while for group 2 about (66.7)of patients were of grade 1 and about ( 20%)of patients were of grade 2 while about ( 13.3)of patients were of grade 3 we approved that proved that SLN biopsy has relatively equal values like lymphadenectomy in staging of endometrial cancer with sensitivity 80% and specificity 90%. Sentinel mapping had good sensitivity and specificity diagnostic potentials.

Palliative treatment of endometrial cancer: what is the role of anastrozole in elderly women?

BackgroundType I endometrial cancer is the most common gynaecological tumour in developed countries and its incidence is increasing also because of population aging. The aim of this work is to test the feasibility and safety of anastrozole as palliative treatment of endometrial cancer in elderly women ineligible for standard surgical treatment.MethodsPatients with histological diagnosis of type I endometrial cancer not suitable for surgical treatment were enrolled in this pilot study. Anastrozole was administered 1 mg daily orally after performing an accurate clinical and radiological staging. Validated questionnaire and self-reported outcomes were used to evaluate quality of life and compliance during the study period.ResultsEight patients with a mean age of 85 (range 80–88 years) were enrolled. All patients had endometrial cancer confined to the uterus, and none progression of disease was observed during the study period. A partial response to the therapy was reported in seven patients, while one patient had stable disease. Tumour symptoms improvement such as pain, vaginal bleeding and vaginal discomfort was reported. The endometrial thickness after twelve months has showed a reduction of 9.25 ± 4.77 mm. The average follow-up time was 18.25 months. Four women died for non oncological reasons, none death related to endometrial cancer was reported. Evaluation of symptoms showed a significant reduction of appetite loss and insomnia, while a significant increase of global health status and fatigue was reported.ConclusionsOur preliminary data suggested that the palliative use of anastrozole may be a suitable therapy for the proper management of early stages endometrial cancer in elderly women not suitable for surgical treatment with good compliance and tolerance.Trial registration2013000840. Date of registration: 21/09/2013. URL: trials.sanmatteo.loc.

Phase II trial evaluating efficacy of a Fitbit program for improving the health of endometrial cancer survivors

BackgroundDespite the favorable prognosis of early stage endometrial cancer, mortality from cardiovascular disease is high. We aimed to evaluate the efficacy of a Fitbit program to improve physical activity in endometrial cancer survivors. MethodsEligible patients were diagnosed with stage IA-IIIA endometrial adenocarcinoma, ≥3 months out from treatment. Participants received a Fitbit Alta and were randomized to receive communication via telephone or electronic methods (email/text). Communication was every two weeks for two months, then once during months four and five. Average daily steps were assessed weekly for nine months. ResultsThe 46 analyzable patients demonstrated a baseline of 5641 median daily average steps. Average steps increased by 22% at 6 months but decreased to baseline by nine months. Baseline activity level (daily steps and walks per week) was the greatest predictor of activity level. Only the telephone intervention participants demonstrated increased activity level at several timepoints, although not maintained by nine months. BMI was unchanged. There was mild improvement in physical and social well-being in those with low baseline well-being (p = 0.009 and 0.014, respectively), regardless of intervention group. Emotional well-being correlated with step count (p = 0.005). ConclusionsActivity level was low and mildly improved on the Fitbit program with the telephone intervention, but effects did not persist by study completion. The program had the greatest impact on a select group of telephone intervention patients with high baseline walking frequency and low baseline step count. Others may require more intense intervention to promote more robust/persistent lifestyle changes.

Lymphadenectomy is associated with an increased risk of postoperative venous thromboembolism in early stage endometrial cancer

ObjectivesIn patients undergoing surgery for early stage endometrial cancer, we sought to evaluate the effect of lymphadenectomy (LND), as well as surgical route, on the risk of postoperative venous thromboembolism (VTE). MethodsThe Surveillance, Epidemiology, and End Results cancer registries (2000−2013) linked to Medicare claims follow up from 1999 to 2014 was accessed to identify those with stage I-II endometrioid endometrial cancer who underwent hysterectomy. Performance of LND, 90-day incidence of postoperative VTE, open vs minimally invasive surgery (MIS), demographics, comorbidities, grade, and stage were collected. A washout period of 12 months with no prior VTE was required. t-test, Chi square test, univariate and multivariable Poisson regression with robust variance estimator were used. ResultsA total of 15,101 patients had hysterectomy for early stage endometrial cancer. LND was performed in 9004 (60%) patients. VTE was found in 486 patients. There were 346 VTEs (3.8%) in the LND group vs 140 (2.3%) in those without LND (RR = 1.67, p < 0.0001). Adjusting for age, stage, grade, comorbidities and surgical approach, LND remained a significant risk for VTE (RR = 1.7, p < 0.001). In those who underwent MIS, LND was associated with a two-fold increase in the risk of VTE (p = 0.0008) (adjusted RR = 1.99, p = 0.0014) and had a statistically comparable rate of VTE when compared to the open surgical approach (p = 0.054). ConclusionsLND is associated with an increased 90-day risk of postoperative VTE in patients undergoing surgery for early stage endometrial cancer. The need for extended postoperative VTE prophylaxis in patients undergoing LND via MIS needs further exploration.

Evaluation of the Safety of Ovarian Preservation at Early Stage of Endometrial Cancer in Premenopausal Women

Background: Endometrial cancer usually occurs at postmenopause stage of life but its incidence in younger patients is increasing in the last decades. The objective of the study was to evaluate the ovarian preservation in the early stage of endometrial cancer. Methods: In this cross-sectional study, 174 patients with endometrial cancer who underwent Total Abdominal Hysterectomy (TAH) and Bilateral Salpingo-oophorectomy in 5 years were included. Results: The results showed that 51.1% of the patients were at stage IA, 28.7% at stage IB, 6.9% at stage II, 11.5% at stage III and 1.7% at stage IV of endometrial cancer when they underwent surgery. One patient (1.12%) at stage IA of endometrial cancer, one patient (2%) at stage IB and one patient (8.3%) at stage II had micrometastasis in ovaries, and 8 patients (40%) at stage III and 2 patients (66.6%) at stage IV had micrometastasis and co-existing tumor. Conclusion: In conclusion, findings revealed the high safety of ovarian preservation in endometrial cancer at earlier stages of the endometrial cancer with low risk of ovarian involvement.

Disease Free Survival of Stage I Endometrial Cancer after Surgery with or without Adjuvant Treatment

This study aimed to define the disease free survival (DFS) and factors associated with recurrence in stage I endometrial cancer after surgery with and without adjuvant treatment. The demographic data, pathological results, adjuvant treatment (AT) and the outcome of patients with endometrial cancer stage I after surgery in Songklanagarind Hospital between January 2002 and July 2014 were collected. The DFS was analyzed by survival analysis and represented by Kaplan–Meier curves. The difference of DFS between AT and non-adjuvant treatment (NAT) groups was tested by the log-rank test. Distributions of risk factors by AT and recurrent status were analyzed using chi-square or Fisher exact tests for discrete factors, and unpaired t or Wilcoxon rank-sum tests for continuous factors. The 5-year DFS was; 91.6%, from a total of 268 patients. DFS in the NAT group was significantly better than that in the AT group (95.2 versus 86.5%, p-value = 0.01). Factors associated with recurrence in the NAT group were age, tumor grading, tumor size, and presence of lymphovascular involvement. Among the AT group, age and ratio of myometrial invasion were associated with recurrence. DFS in NAT was better than in AT and the potential factors associated with recurrence, after surgery with or without AT, were not the same.