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Published on: September 12, 2019
Prognostic characteristics and recurrence patterns of grade 1 endometrial carcinoma: a large retrospective analysis
Negin Sadeghi1, Jacopo Conforti2,3, Andreas Zouridis1
1Department of Obstetrics and Gynaecology, John Radcliffe Hospitals, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Background:
Endometrial cancer (EC) is the most common tumour of the female reproductive system, and low-grade EC is the histological type with the best prognosis for its less aggressiveness. Abnormal uterine bleeding is one of the first symptoms that appears and that allows an early diagnosis, while the disease is still confined into the uterus. The objective of this study was to identify risk factors associated with recurrence in low-grade EC across International Federation of Gynaecology and Obstetrics (FIGO) 2009 stages I to IV.
Methods:
This is a retrospective study that collected patients surgically treated at the Thames Valley Cancer Centre from March 2010 to January 2020 for low-grade EC. All cases were debated at the multidisciplinary team discussion, both prior to and following surgery, to decide the surgical approach and the need for adjuvant treatments. Clinical, surgical and histopathological data were gathered from electronic patient record and used for the statistical analysis.
Results:
A total of 238 patients were included. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were favourable, with follow-up nearing 10 years. However, 14 patients (5.88%) experienced recurrence, 11 of whom (78.5%) were initially diagnosed at stage I. The median time from surgery to relapse was 30 months. The vaginal vault was the most common site of recurrence (42%), followed by pelvic lymph nodes and distant metastases. Only myometrial invasion (P=0.049) and serosal involvement (P=0.01) were statistically significant predictors of recurrence in both univariate and multivariate analyses.
Conclusions:
This study confirms that deep myometrial invasion and serosal involvement are significant predictors of recurrence and poor outcomes in grade 1 EC. Other factors, such as lymphovascular space invasion and lymph node positivity, were not confirmed as significant. Before recommending adjuvant treatment for low-grade EC patients exhibiting these risk factors, further prospective trials are necessary.
