Prognostic value of cervical involvement in advanced endometrial cancer

Endometrial cancer is the most common gynecologic malignancy in the United States and a leading cause of gynecologic cancer mortality worldwide. Although most cases are diagnosed early, 15% to 25% present with advanced disease and have poor outcomes. The prognostic significance of cervical involvement in advanced endometrial cancer remains unclear. This study evaluated cervical stromal involvement using the International Federation of Gynecology and Obstetrics 2023 classification in a large advanced-stage cohort.

We performed a retrospective cohort study of 363 patients with advanced-stage endometrial cancer surgically treated at a single institution between 2005 and 2022. Cervical involvement was defined as stromal infiltration. Clinical, pathological, and treatment variables were collected. Disease-free survival and overall survival were assessed with Kaplan-Meier estimates and Cox proportional hazards models. Disease-free survival was further analyzed adjusting for American Society of Anesthesiologists (ASA) classification, tumor grade, and lymphovascular space invasion.

Cervical involvement was observed in 122 patients (33.6%). Univariate analysis showed reduced disease-free survival in patients with cervical involvement (5-year disease-free survival: 39.8% vs 48.3%; hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.04 to 1.87, p = .02), while overall survival differences were not significant. After adjustment, cervical involvement lost independent prognostic significance (disease-free survival: HR 1.20, 95% CI 0.85 to 1.69, p = .29). ASA status, high tumor grade, and lymphovascular space invasion remained strong predictors of recurrence. Surgical approach did not impact survival outcomes.

Cervical involvement reflects tumor aggressiveness but is not an independent predictor of recurrence or survival in advanced endometrial cancer.