- Volume 16 Issue 17
Aims: To analyse the predictors of recurrence, disease free survival and overall survival in cases with endometrial cancer. Materials and Methods: A total of 152 women diagnosed with endometrial cancer were screened using a prospectively collected database including age, smoking history, menopausal status, body mass index, CA125, systemic disorders, tumor histology, tumor grade, lymphovascular space invasion, tumor diameter, cervical involvement, myometrial invasion, adnexal metastases, positive cytology, serosal involvement, other pelvic metastases, type of surgery, fertility sparing approach to assess their ability to predict recurrence, disease free survival and overall survival. Results: In ROC analyses tumor diameter was a significant predictor of recurrence (AUC:0.771, P<0.001). The optimal cut off value was 3.75 with 82% sensitivity and 63% specificity. In correlation analyses tumor grade (r=0.267, p=0.001), tumor diameter (r=0.297, p<0.001) and the serosal involvement (r=0.464, p<0.001) were found to significantly correlate with the recurrence. In Cox regression analyses when some different combinations of variables included in the model which are found to be significantly associated with the presence of recurrence, tumor diameter was found to be a significant confounder for disease free survival (OR=1.2(95 CI,1.016-1.394, P=0.031). On Cox regression for overall survival only serosal involvement was found to be a significant predictor (OR=20.8 (95 % CI 2.4-179.2, P=0.006). In univariate analysis of tumor diameter > 3.75 cm and the recurrence, there was 14 (21.9 %) cases with recurrence in group with high tumor diameter where as only 3 (3.4 %) cases group with smaller tumor size (Odds ratio:7.9 (95 %CI 2.2-28.9, p<0.001). Conclusions: Although most of the significantly correlated variables are part of the FIGO staging, tumor diameter was also found to be predictor for recurrence with higher values than generally accepted.
Endometrial cancer;tumor diameter;overall survival;disease free survival
- AlHilli MM, Podratz KC, Dowdy SC, et al (2013). Preoperative biopsy and intraoperative tumor diameter predict lymph node dissemination in endometrial cancer. Gynecol Oncol, 128, 294-9. https://doi.org/10.1016/j.ygyno.2012.10.009
- Benedetti Panici P, Basile S, Maneschi F, et al (2008). Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst, 100, 1707-16. https://doi.org/10.1093/jnci/djn397
- Binesh F, Akhavan A, Behniafard N, et al (2014). Endometrial adenocarcinoma: clinicopathologic and survival characteristics in Yazd, Iran. Asian Pac J Cancer Prev, 15, 2797-801. https://doi.org/10.7314/APJCP.2014.15.6.2797
- Creasman WT, Odicino F, Maisonneuve P, et al (2006). Carcinoma of the corpus uteri. FIGO 26th Annual Report on the results of treatment in ynecological cancer. Int J Gynaecol Obstet, 95, 105-43. https://doi.org/10.1016/S0020-7292(06)60031-3
- Dunn EF, Geye H, Platta CS, et al (2014). Predictive factors of recurrence following adjuvant vaginal cuff brachytherapy alone for stage I endometrial cancer. Gynecol Oncol, 133, 494-8. https://doi.org/10.1016/j.ygyno.2014.03.554
- Doll KM, Tseng J, Denslow SA, et al (2014). High-grade endometrial cancer: revisiting the impact of tumor size and location on outcomes. Gynecol Oncol, 132, 44-9. https://doi.org/10.1016/j.ygyno.2013.10.023
- Kitchener H, Swart AM, Qian Q, et al (2009). Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet, 373, 125-36. https://doi.org/10.1016/S0140-6736(08)61766-3
- Kumar S, Bandyopadhyay S, Semaan A, et al (2011). The role of frozen section in surgical staging of low risk endometrial cancer. PLoS One, 6, 21912. https://doi.org/10.1371/journal.pone.0021912
- Mahdi H, Munkarah AR, Ali-Fehmi R, et al (2014). Tumor size is an independent predictor of lymph node metastasis and survival in early stage endometrioid endometrial cancer. Arch Gynecol Obstet. Dec 31. [Epub ahead of print]
- Seracchioli R, Solfrini S, Mabrouk M, et al (2010). Controversies in surgical staging of endometrial cancer. Obstet Gynecol Int, 181963.
- Sethasathien P, Charoenkwan K, Siriaunkgul S, et al (2014). Accuracy of intraoperative gross examination of myometrial invasion in stage I-II endometrial cancer. Asian Pac J Cancer Prev, 15, 7061-4. https://doi.org/10.7314/APJCP.2014.15.17.7061
- Shah C, Johnson EB, Everett E, et al (2005). Does size matter? Tumor size and morphology as predictors of nodal status and recurrence in endometrial cancer. Gynecol Oncol, 99, 564-70. https://doi.org/10.1016/j.ygyno.2005.06.011
- Siegel R, Naishadham D, Jemal A, et al (2012). Cancer statistics. CA Cancer J Clin, 62, 10-29. https://doi.org/10.3322/caac.20138
- Yanazume S, Saito T, Eto T, et al (2011). Reassessment of the utility of frozen sections in endometrial cancer surgery using tumor diameter as an additional factor. Am J Obstet Gynecol, 204, 531.
- Ytre-Hauge S, Husby JA, Magnussen IJ, et al (2015). Preoperative tumor size at MRI predicts deep myometrial invasion, lymph node metastases, and patient outcome in endometrial carcinomas. Int J Gynecol Cancer, 25, 459-66. https://doi.org/10.1097/IGC.0000000000000367
- Tumor Size, an Additional Risk Factor of Local Recurrence in Low-Risk Endometrial Cancer vol.28, pp.4, 2018, https://doi.org/10.1097/IGC.0000000000001223