Prognostic determinants of survival in early-stage endometrial cancer: A retrospective analysis

The aim of this study was to investigate prognostic determinants of survival in early-stage endometrial cancer (EC), focusing on clinicopathological parameters including histologic grade, tumor stage, myometrial invasion, lymphovascular space invasion (LVSI), and preoperative CA-125, as well as the role of adjuvant therapies in disease-free survival (DFS) and overall survival (OS).

We retrospectively analyzed women treated surgically for International Federation of Gynecology and Obstetrics 2009 stage I-II EC at a tertiary center between January 2011 and January 2023. Demographic and pathological data were collected, including age, body mass index, reproductive history, menopausal status, comorbidities, tumor size, histologic subtype and grade, depth of myometrial invasion, LVSI, serum CA-125 levels, and surgical procedures. Adjuvant therapies-external beam radiotherapy, vaginal brachytherapy, and chemotherapy-were also documented. Associations between these variables and survival outcomes were assessed using Kaplan-Meier and Cox regression analyses.

A total of 241 women with early-stage EC were included. Median age was 57 years (range: 34-86 years). Of these, 181 (75.1%) were stage IA, 47 (19.5%) were stage IB, and 13 (5.4%) were stage II. Histologic grades were grade 1 in 44.8%, grade 2 in 39.0%, and grade 3 in 16.2%. During a median follow-up of 75 months, recurrence occurred in 4.6% of patients and mortality in 7.9% of patients. Univariate analysis showed that elevated CA-125, higher stage, and higher grade were associated with worse OS. Multivariate analysis identified histologic grade as an independent predictor of both OS and DFS. Neither adjuvant radiotherapy nor chemotherapy improved survival outcomes.

Histologic grade was the strongest independent prognostic factor for OS and DFS in early-stage EC, surpassing tumor stage, myometrial invasion, and LVSI. These findings highlight the importance of comprehensive surgical staging, especially when high-grade tumors are detected intraoperatively, to ensure accurate risk stratification and appropriate use of adjuvant therapies.