415 Prognostic factors for recurrence in carcinoma endometrium (original) (raw)
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Risk Factors for Recurrence in Low-Risk Endometrial Cancer: A Case-Control Study
Oncology research and treatment, 2018
The aim of this study was to investigate the risk factors for recurrence in patients with low-risk endometrial cancer (EC). This retrospective study was performed using 10 gynecological oncology department databases. Patients who met the following criteria were included in the study: (a) endometrioid-type histology, (b) histological grade 1 or 2, (c) no or < 50% myometrial invasion, (d) no intraoperative evidence of extrauterine spread, and (e) the patient underwent at least a pelvic lymphadenectomy. Recurrence was detected in 56 patients who were histologically diagnosed with low-risk EC, and these patients made up the case group. A total of 224 patients with low-risk EC without recurrence were selected (control group) using a dependent random sampling method. The case and control groups were match-paired in terms of grade, stage, and operative technique. Lymphovascular space invasion (LVSI) (odds ratio (OR) 5.8, 95% confidence interval (CI) 2.0-16.9; p = 0.001) and primary tumo...
Prognostic factors for recurrence and survival in primary vulvar squamous cell cancer
Acta Obstetricia et Gynecologica Scandinavica, 2008
The aim of this study was to determine the possible prognostic factors in patients with uterine leiomyosarcoma (LMS). Methods This study retrospectively investigated 50 patients with uterine LMS treated at the Samsung Medical Center between 2001 and 2017. To analyze the prognostic significance of factors for recurrence-free survival (RFS), overall survival (OS), and survival after recurrence, the log-rank test and Cox proportional hazards model were used for univariate and multivariate analysis. Results Of the 50 patients, 30 (60.0%) experienced recurrence and 16 (32.0%) died within a median follow-up period of 21 (range, 3-99) months. Multivariate analysis revealed that older age, absence of residual tumor after surgery, lower mitotic count, and a history of adjuvant radiotherapy at first treatment were significantly associated with better RFS. Presence of residual tumor after surgery and severe nuclear atypia were associated with poor OS. In the analysis of survival after recurrence, hematogenous recurrence, severe nuclear atypia, and presence of residual tumor at primary surgery were significantly associated with worse prognosis. Notably, residual tumor status at primary surgery was associated with RFS, OS, and survival after recurrence. Conclusion We demonstrated the possible prognostic factors for RFS, OS, and survival after recurrence for patients with LMS. These results may provide useful information for patients with LMS.
Assessment of risk factors for lymph node metastasis in endometrial cancer
Istanbul Medical Journal, 2019
Amaç: Endometriyum kanseri nedeni ile evreleme operasyonu yapılan olgularda lenf nodu (pelvik ve/veya paraaortik lenf nodları) metastazı için risk oluşturan klinik ve patolojik faktörlerin belirlenmesidir. Yöntemler: Çalışmamızda 2007-2016 yılları arasında endometriyum kanseri tanısı ile evreleme cerrahisi uygulanan 143 olgunun klinik ve patolojik özellikleri retrospektif olarak incelendi. Lenf nodu metastazı için risk faktörlerinin belirlenmesinde doğrusal regresyon analizi, lojistik regresyon analizi, Spearman korelasyon testi ve işlem karakteristik eğrisi testleri kullanıldı. Tüm istatistiksel değerlendirmeler için p<0,05 anlamlı kabul edildi. Bulgular: Beş olguda (%3,5) sadece pelvik, 3 olguda (%2,1) sadece paraaortik, 5 olguda (%3,5) ise hem pelvik hem de paraaortik lenf nodu olmak üzere 13 olguda (%9,1) lenf nodu metastazı mevcuttu. Doğrusal regresyon analizinde non-endometrioid histolojik tip, derin miyometrial invazyon (≥%50 invazyon derinliği), ileri histolojik grade, lenfovasküler alan invazyonu, pozitif peritoneal sitoloji ve tümör boyutu ile lenf nodu metastazı arasında anlamlı ilişki bulundu (p<0,05). Tümör boyutu ile lenf nodu metastazı arasında pozitif korelasyon mevcuttu ve işlem karakteristik eğrisinde 4,25 cm tümör boyutu lenf nodu metastazı için en uygun sınır değer olarak tespit edildi (duyarlılık %83, özgüllük %75). Regresyon analizinde ise lenfovasküler alan invazyonu lenf nodu metastazı için bağımsız tek risk faktörü olarak belirlendi (odss oranı: 11,8; %95 güven aralığı: 1,8-75,4; p=0,009). Sonuç: Endometriyal kanserli olgularda lenfovasküler alan invazyonu lenf nodu metastazı için bağımsız tek risk faktörüdür. Tümör boyutu ile lenf nodu metastazı arasındaki korelasyon ise doğrusaldır. Lenf nodu metastazı için tümör boyutunun sınır değerini belirlemede yeni çalışmalara ihtiyaç vardır. Anahtar Kelimeler: Endometriyal karsinoma, lenfatik metastaz, lojistik model Introduction: To determine the clinical and pathologic factors that are risk factors for metastasis of the lymph nodes (pelvic and/or aortic lymph nodes) in cases who underwent staging surgery due to endometrial carcinoma. Methods: The clinical and pathological characteristics of 143 patients who underwent staging surgery between 2007 and 2016 were retrospectively analyzed. Linear regression analysis, logistic regression analysis, Spearman correlation and Receiver operator curve tests were used to determine risk factors for lymph node metastasis. P<0.05 was considered significant in all statistical evaluations. Results: Thirteen cases (9.1%) had lymph node metastasis [5 cases (3.5%) only pelvic, 3 cases (2.1%) only paraaortic, 5 cases (3.5%) both pelvic and paraaortic lymph node]. In linear regression analysis, there was a significant correlation between lymph node metastasis and non-endometrioid histological type, deep myometrial invasion (≥50% invasion depth), advanced histologic grade, lymphovascular space invasion, positive peritoneal cytology and tumor size (p<0.05). The correlation between tumor size and lymph node metastasis was positive, and Receiver operator curve revealed 4.25 cm tumor size was the most appropriate cutoff value for risk of lymph node metastasis (sensitivity=83%, specificity=75%). In logistic regression analysis, lymphovascular space invasion was the only independent risk factor for nodal metastasis (odss ratio: 11.8; 95% confidence interval: 1.8-75.4, p=0.009). Conclusion: In endometrial cancer cases, lymphovascular space invasion is the only independent risk factor for lymph node metastasis. There is linear correlation between tumor size and lymph node metastasis. Further studies is needed to determine the limit value of tumor size for lymph node metastasis.
European Journal of Surgical Oncology (EJSO), 2012
Objective: To study the temporal pattern of endometrial cancer recurrence in relation to histological risk factors in a large multicenter setting. Methods: 843 patients with apparent stage I endometrial cancer were followed for a median time of 38 months, documenting all recurrences. Patients were stratified as high risk based on the presence of at least one of the established histological risk factors: high tumor grade, penetration to the outer half of the myometrium, lymphvascular space involvement, lower uterine segment involvement and non endometroid histology. Survival analysis, including KaplaneMeier curves, log-rank tests and multi-variate Cox proportional hazard regression were used to evaluate the equality of recurrence-free distributions for different levels of risk. Results: Recurrence was documented in 66 cases. The presence of one or more of the histological risk factors was associated with significantly shorter recurrence free survival, not attenuating over time ( p < 0.001). Age-adjusted Cox regression model demonstrated a significantly decreased recurrence-free survival (HR ¼ 2.8 95% CI 1.5, 5.1) in the presence of risk factors. Conclusions: In patients with stage I endometrial cancer, the presence of histological risk factors is associated with a significantly higher recurrence rate, which does not attenuate over follow up time. This may allow for a selective approach in the follow-up of endometrial cancer patients.
International Journal of Gynecological Pathology, 2014
Endometrial adenocarcinoma is the most common gynecologic cancer in the United States. The prognosis is generally favorable, however, a significant number of patients do develop local or distant recurrence. The most common site of recurrence is vaginal. Our aim was to better characterize patients with vaginal recurrence of low-grade endometrioid adenocarcinoma with respect to associated tumor parameters and clinical outcome. We compiled 255 cases of low-grade (FIGO Grade I or II) endometrioid adenocarcinoma on hysterectomy specimens with lymph node dissection. A total of 113 cases with positive lymph nodes or recurrent disease were included in our study group. Seventy-three cases (13 Grade 1, 60 Grade 2) developed extravaginal recurrence and 40 cases (7 Grade 1, 33 Grade 2) developed vaginal recurrence. We evaluated numerous tumor parameters including: percentage myoinvasion, presence of microcystic, elongated, and fragmented pattern of myoinvasion, lymphovascular space invasion, and cervical involvement. Clinical follow-up showed that 30% (34/113) of all patients with recurrent disease died as a result of their disease during our follow-up period, including 31 (42.5%) with extravaginal recurrence and 3 (7.5%) with primary vaginal recurrence (P = 0.001). The 3 patients with vaginal recurrence developed subsequent extravaginal recurrence before death. Vaginal recurrence patients show increased cervical involvement by tumor, but lack other risk factors associated with recurrent disease at other sites. There were no deaths among patients with isolated vaginal recurrence, suggesting that vaginal recurrence is not a marker of aggressive tumor biology.
Indian Journal of Gynecologic Oncology, 2019
Introduction Endometrial cancer usually has a good prognosis. The recurrence and survival in endometrial cancer are based on multiple prognostic factors like patient age, histological grade, myometrial invasion, and lymphovascular space invasion. We investigated various clinicopathological features determining tumor recurrence in stage I endometrial cancer with endometrioid histology. Methods We retrospectively reviewed stage I endometrial cancer patients who underwent surgery at the Basavatarakam Indo American Cancer Hospital between 2010 and 2015. Patients who had tumor recurrence were documented. Various risk factors like size, grade, depth, lymphovascular involvement, etc., were studied, their relation with recurrence was noted, and statistical analysis was done. Results Twenty-three patients exhibited tumor recurrence in stage I EEC (13.3%). When considering the depth of myometrial invasion, the 5-year RFS of stage IA EEC is 90.4% in comparison with 66.6% when the depth of invasion is more than half of myometrial invasion. The 5-year RFS of the patients with stage I EEC is 100% in tumors with size less than 2 cms, 92.15% in tumor size 2-4 cms, and 70.45% when the tumor size is greater than 4 cms. The 5-year RFS of the patients is 94.7% in grade 1, 87.3% in grade 2, and 54.2% in grade 3. Conclusion Depth of myometrial invasion, grade, and size of the primary tumor are shown to affect recurrence. LUS involvement, intracervical glandular involvement, and the lymphovascular space invasion did not affect recurrence in endometrioid endometrial cancer.
Prognostic risk factors for lymph node involvement in patients with endometrial cancer
Journal of Turkish Society of Obstetric and Gynecology, 2017
Amaç: Endometrium kanseri olgularında lenf nodu (LN) tutulumunu etkileyen değişkenlerin analizi ve lenfadenektomi gereksiniminin değerlendirilmesidir. Gereç ve Yöntemler: 2009 ve 2012 yılları arasında sistematik pelvik veya kombine pelvik ve paraaortik lenfadenektomi yapılan ardışık 128 endometrium kanseri olgusunu içeren tek merkezli bir retrospektif analiz yapıldı. Tek değişkenli analiz için Mann-Whitney U testi, ki-kare testi ve Fisher exact testi kullanıldı. Tek değişkenli analizde p değeri 0,05'ten küçük olan değişkenler çok değişkenli lojistik regresyon analizine dahil edildi. Değişkenlerin LN tutulumu üzerine olan etkileri göreceli olasılıklar oranları (OR) ve %95 güven aralığı (GA) ile belirtildi. Bulgular: Tek değişkenli analizde, grade 2-3, tümör çapının 3 cm'den büyük olması, derin (>%50) miyometriyal invazyon, servikal, adneksal veya omental tutulumun olması, pozitif peritoneal sitoloji, açık cerrahi yaklaşım, kombine pelvik ve paraaortik lenfadenektomi ve toplam çıkarılan LN sayısı (>30) LN tutulumu ile ilişkili olarak bulundu. Ancak çok değişkenli analiz sonucunda sadece toplam çıkarılan LN sayısı (>30) LN tutulumunu öngördüren bağımsız bir değişken olarak kaldı [OR: 15,08; %95 GA: (1,28-177,59); p=0,03]. Sonuç: Bu çalışma endometrium kanserinin evrelenmesi esnasında ne kadar çok LN çıkartılırsa o kadar yüksek olasılıkla LN metastazının saptanabileceğini göstermektedir.
Patterns of recurrence in patients with squamous cell carcinoma of the vulva
Cancer, 2000
Invasive vulvar carcinoma is a rare disease with an incidence rate of 3-5% of all female genital neoplasms. The current study discusses the limited number of articles in the literature regarding the patterns of recurrence as well as the clinical outcome of patients with recurrent disease based on a consistent and consecutive series of cases.
Acta Obstetricia et Gynecologica Scandinavica, 2008
Background. The aim of this study was to determine predictors for loco-regional or distant recurrence of disease in a subgroup of intermediate or high risk stage I and II endometrial cancer. Methods. A retrospective analysis of 295 patients with histopathological stage I and II, intermediate or high risk endometrial cancer is reported. The following factors were studied: stage, grade, age, histologic diagnosis, lymphadenectomy, lymphovascular space invasion, and adjuvant radiotherapy. The Log-Rank test was used for statistical analyses and the KaplanÁMeyer method was used for time-toevent analysis. Multivariate analysis was also performed. Results. Thirty-four (11.5%) patients developed a recurrence; 20 (59%) developed loco-regional recurrence, and 14 (41%) developed distant recurrence. In 20 women (59%), recurrence appeared within 3 years of surgery, and the actuarial survival at 3 years after recurrence was 29%. Multivariate analysis showed that for recurrence, age 60 years was a significant unfavourable prognostic factor (p B0.05). Conclusions. We found low rates of recurrence in patients with early stage intermediate or high risk endometrial cancer. Only age was identified as an independent significant predictor for recurrence.