Reviewing prognostic factors associated with recurrence in clinically early-stage low-risk endometrial cancer

Abstract

Objective: We sought to re-explore the association between well-known prognostic factors and recurrence in presumed early-stage low-risk endometrial cancer (EC). Methods: A retrospective cohort study was carried out on patients who underwent surgical treatment by the same surgeon for presumed early-stage low-risk EC between September 2003 to August 2017. The prognostic value of well-known clinicopathological factors for diseasefree survival (DFS) was reviewed by univariate log-rank test. Results: One hundred and five patients fit the criteria for this analysis. These patients underwent total hysterectomy plus bilateral salpingo-oophorectomy with no lymph nodes dissection (10.5%) or with a sampling dissection alone (89.5%). Adjuvant therapies were applied in 52 (40.1%) of them as pelvic radiotherapy (29.5%) or chemoradiation (11.4%). Our cumulative 3y-DFS and OS were 88.1% and 97.7%, respectively. The univariate survival analysis confirmed histological grade 3 (3y-DFS of 89.9% vs. 33.3%, p=0.004), MMI ≥50% (3y-DFS of 95.2% vs. 71.3%, p=0.003), lymph node metastasis (3y-DFS of 88.3% vs. 60%; p=0.028) and more advanced pathological stages (3y-DFS of 91.2% vs. 56.3; p<0.001) as significantly associated to recurrences. Conclusion: We confirmed the association of classical prognostic factors such as high histological grade, deeper MMI, lymph node metastasis and more advanced pathological stages with disease recurrence in this cohort of patients from Northeast Brazil. Further efforts are needed to avoid overtreatment in patients with low risk of relapses.