Determining the optimal follow-up protocol after primary surgery in patients with early-stage endometrial cancer

The aim of this study was to investigate the timing of recurrence in patients with early-stage endometrial cancer and to determine the optimal postoperative follow-up protocol for the detection of recurrence.

Patients with stage 1 and 2, grade 1-3 endometrioid type endometrial cancer who underwent follow-up for at least two years were included. The diagnostic method for recurrence was analyzed for each patient. Analysis of risk factors for recurrence were done using SPSS. Sensitivity analyzes were performed comparing the diagnostic methods.

A total of 303 patients were included and recurrence was diagnosed in 17 (5.61%). Cumulative risk of recurrence was 3.06% in the first 23 months, rising to 7.52% in the first 33 months. Sensitivity of physical examination (PE) was 50.00%, specificity 99.52%, positive predictive value 88.89%, negative predictive value 96.30% and accuracy rate 96.00% respectively. It was found that each step increase of grade increased recurrence odds by 2.549 times [95% confidence interval (CI): 1.078-6.027; p=0.033] while each step increase of stage increased recurrence odds by 2.943 times (95% CI: 1.270-6.820; p=0.012).

It is notable that recurrence rate increased after 25 months and the risk of recurrence increased as the tumor stage and grade worsened. Symptoms in patients with high-grade and deep myometrial invasion, especially after the first two years, should be considered risky and patients should be informed about seeking medical care when symptoms occur. PE and symptoms of patients are key factors in detecting reccurence while other diagnostic methods can be used according to clinical findings.