2022-RA-1357-ESGO Factors associated with an increased risk of recurrence in endometrial cancer patients: a retrospective cohort study

Introduction/Background

The aim of this study was to identify clinical and pathologic factors associated with the risk of recurrence in patients with endometrial cancer (EC).

Methodology

We included patients who underwent surgery for EC in our institution between 2007 and 2019. Data on demographic characteristics, surgery and pathology reports, adjuvant treatment and follow-up was collected from electronic patient files. Patients were divided into two groups: recurrence and no recurrence. Clinical and pathologic factors were compared using Student T-test, Chi-square or Fisher’s exact test. Univariate and multivariate Cox-proportional hazard models were used to assess the impact of the evaluated factors on the risk of recurrence.

Results

In total 286 patients were included in the analysis. In a mean follow-up time of 59 months, EC recurrence was diagnosed in 60 (20.9%) patients, 75% of which were diagnosed in the first 24 months after surgery. Compared to patients with no recurrence, patients with recurrent EC had more frequently type II (56.7%vs.25.2%), high-grade (61.7%vs.32.7%), stage III-IV tumors (35%vs.17.3%), tumor>2 cm (95%vs.78.8%), myometrial infiltration>50% (48.3%vs.29.2%) and lympho-vascular space invasion (LVSI; 60.9%vs.25.8%). Lymphadenectomy had been indicated more often in patients with recurrent EC (71.7%vs.44.2%), however, there was no association between performance of lymphadenectomy and EC recurrence. In univariate survival analysis, risk of recurrence was higher in patients with type II (HR:4.12;p<0.001), high-grade tumors (HR:3.06;p<0.001), tumor>2 cm (HR:4.93;p=0.007), myometrial infiltration>50% (HR:2.43;p=0.001), cervix infiltration (HR:2.29;p<0.001), adnexal tumor (HR:1.97;p=0.031), LVSI (HR:4.39,p=0.001) and stage IV (HR:6.85;p<0.001). In multivariate analysis, only LVSI remained significantly associated with an increased risk of recurrence (HR:5.36;p=0.017).

Conclusion

LVSI is an independent risk factor for EC recurrence, while performing lymphadenectomy had no impact on the risk of recurrence. Identifying patients with a higher risk of EC recurrence is important in order to concentrate follow-up efforts on patients who can benefit the most from it.