Why do some patients with stage 1A and 1B endometrial endometrioid carcinoma experience recurrence? A retrospective study in search of prognostic factors

Abstract

Objectives: Endometrial endometrioid carcinoma (EEC) is the most encountered subtype of endometrial cancer (EC). Our study aimed to investigate the factors affecting recurrence in patients with stage 1A and 1B EEC. Material and methods:Our study included 284 patients diagnosed with the International Federation of Gynecology and Obstetrics stage 1A/1B EEC in our center from 2010 to 2018.The clinicopathological characteristics of the patients were obtained retrospectively from their electronic files. Results:The median age of the patients was 60 years (range 31-89). The median follow-up time of the patients was 63.6 months (range 3.3-185.6). Twenty-two (7.74%) patients relapsed during follow-up. Among the relapsed patients, 59.1% were at stage 1A ECC, and 40.9% were at stage 1B. In our study, the one-, three-, and five-year recurrence-free survival (RFS) rates were 98.9%, 95.4%, and 92.9%, respectively. In the multivariate analysis, grade and tumor size were found to be independent parameters of RFS in all stage 1 EEC patients.Furthermore, the Ki-67 index was found to affect RFS in stage 1A EEC patients, and tumor grade affected RFS in stage 1B EEC patients. In the time-dependent receiver operating characteristic curve analysis, the statistically significant cut-off values were determined for tumor size and Ki-67 index in stage 1 EEC patients.Conclusions: Stage 1-EEC patients in the higher risk group in terms of tumor size, Ki-67, and grade should be closely monitored for recurrence. Defining the prognostic factors for recurrence in stage 1 EEC patients may lead to changes in follow-up algorithms.

The prognostic value of P53 index in predicting the recurrence of early low‐risk endometrial cancer

“…patients applied adjuvant radiotherapy in the analysis may have resulted in different outcomes from our study. 9 The Ki67 index was shown to be a prognostic factor for recurrence in EC in the studies conducted by Song and Jiang et al but these studies included both advanced stage and high-risk EC patients as well as early low-risk EC patients. 11,19 As an indicator of increased uncontrolled cell proliferation in EC, the Ki-67 index is expected to be high in advanced high-risk EC and low in early low-risk EC.…”

“…7 In recent years, in addition to traditional clinical and pathological features, immunohistochemical markers such as Ki 67, ER, PR, and P53 have been investigated for their effects on prognosis in EC. [8][9][10] Although there are studies investigating the effect of p53 index on recurrence in patients with advanced high-risk EC, the number of studies investigating the effect of p53 index on recurrence in patients with early low-risk EC is not sufficient. [7][8][9][10][11] Therefore, we aimed to clarify the clinical value of P53 index in patients with early low-risk EC and find an optimal cut-off value of P53 index for predicting the recurrence of these patients.…”

“…[8][9][10] Although there are studies investigating the effect of p53 index on recurrence in patients with advanced high-risk EC, the number of studies investigating the effect of p53 index on recurrence in patients with early low-risk EC is not sufficient. [7][8][9][10][11] Therefore, we aimed to clarify the clinical value of P53 index in patients with early low-risk EC and find an optimal cut-off value of P53 index for predicting the recurrence of these patients. All patients were operated by gynecologic oncologists.…”

The association of tumor diameter with lymph node metastasis and recurrence in patients with endometrial cancer: a systematic review and meta-analysis

“…More RCT studies are needed to confirm the relationship between TD and recurrence It is worth noting that some studies have proposed that the risk of recurrence rise follows the increase of TD in EC patients, and the difference was statistically significant ( 76 , 83 ). There are also some studies ( 20 , 68 , 85 ) which have presented the opposite attitude. This situation may be related to the FIGO stage and pathological grade of the participants.…”

“…This situation may be related to the FIGO stage and pathological grade of the participants. For example, study by Ocak et al ( 68 , 69 ) recruited only FIGO stage-I patients, and the risk of early recurrence in these patients would be relatively low, so that it could not provide the best conclusion. If all the patients included had high pathological grade, the contribution of TD to recurrence might be masked due to the tendency of local and distant recurrence of highly malignant diseases ( 85 ).…”