Surgical stage I endometrial cancer: Predictors of distant failure and death

Andrea Mariani, Maurice J. Webb, Gary Keeney, Timothy G. Lesnick, Karl C. Podratz

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

Objective. The objective was to analyze the effect of various histopathologic characteristics on prognosis in surgical stage I (node-negative) endometrial carcinoma. Methods. During a 10-year period, 229 patients with stage I epithelial (all subtypes) endometrial cancer had hysterectomy and node dissection. Mean number of nodes harvested was 16.2 pelvic and 5.7 paraaortic. Median follow-up was 83 months. Sixty-seven patients (29%) received adjuvant radiotherapy. Results. Five-year disease-related survival (DRS) was 95%, and 5-year relapse-free survival (RFS) 91%. We observed 7 (3%) isolated vaginal recurrences, 14 (6%) distant failures, and 1 (0.4%) simultaneous recurrence at both regional (pelvic sidewall) and distant sites. Only 1 of 7 patients (14%) with vaginal failure died of the disease (median follow-up of censored patients after failure was 110 months), compared with 10 of the 15 patients (67%) with distant failure. By univariate analysis, myometrial invasion (MI) ≥ 66%, nonendometrioid histology, lymphovascular invasion, absence of associated hyperplasia, and tumor diameter >2 cm were significant predictors of poor prognosis with distant failure (P ≤ 0.05). Cox regression analysis identified MI ≥ 66% as the only independent predictor of DRS (P < 0.001, relative risk [RR] = 12.44), RFS (P < 0.001, RR = 8.67), and distant failure (P < 0.001, RR = 24.89). Only 2% of patients with MI < 66% had distant failure and died of the disease at 5 years, compared with a 29% 5-year distant failure rate and a 22% 5-year death rate among patients with MI ≥ 66%. Conclusion. Stage I (negative nodes) endometrial cancer patients with MI ≥ 66% are at significant risk for distant failure and death and should be considered candidates for new randomized trials of adjuvant systemic therapy.

Original languageEnglish (US)
Pages (from-to)274-280
Number of pages7
JournalGynecologic Oncology
Volume87
Issue number3
DOIs
StatePublished - 2002

Fingerprint

Endometrial Neoplasms
Recurrence
Survival
Adjuvant Radiotherapy
Hysterectomy
Hyperplasia
Dissection
Histology
Regression Analysis
Mortality
Neoplasms

Keywords

  • Distant recurrence
  • Endometrial cancer
  • Lymphadenectomy
  • Myometrial invasion
  • Prognosis
  • Recurrence
  • Surgical staging

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Surgical stage I endometrial cancer : Predictors of distant failure and death. / Mariani, Andrea; Webb, Maurice J.; Keeney, Gary; Lesnick, Timothy G.; Podratz, Karl C.

In: Gynecologic Oncology, Vol. 87, No. 3, 2002, p. 274-280.

Research output: Contribution to journalArticle

Mariani, Andrea ; Webb, Maurice J. ; Keeney, Gary ; Lesnick, Timothy G. ; Podratz, Karl C. / Surgical stage I endometrial cancer : Predictors of distant failure and death. In: Gynecologic Oncology. 2002 ; Vol. 87, No. 3. pp. 274-280.
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abstract = "Objective. The objective was to analyze the effect of various histopathologic characteristics on prognosis in surgical stage I (node-negative) endometrial carcinoma. Methods. During a 10-year period, 229 patients with stage I epithelial (all subtypes) endometrial cancer had hysterectomy and node dissection. Mean number of nodes harvested was 16.2 pelvic and 5.7 paraaortic. Median follow-up was 83 months. Sixty-seven patients (29{\%}) received adjuvant radiotherapy. Results. Five-year disease-related survival (DRS) was 95{\%}, and 5-year relapse-free survival (RFS) 91{\%}. We observed 7 (3{\%}) isolated vaginal recurrences, 14 (6{\%}) distant failures, and 1 (0.4{\%}) simultaneous recurrence at both regional (pelvic sidewall) and distant sites. Only 1 of 7 patients (14{\%}) with vaginal failure died of the disease (median follow-up of censored patients after failure was 110 months), compared with 10 of the 15 patients (67{\%}) with distant failure. By univariate analysis, myometrial invasion (MI) ≥ 66{\%}, nonendometrioid histology, lymphovascular invasion, absence of associated hyperplasia, and tumor diameter >2 cm were significant predictors of poor prognosis with distant failure (P ≤ 0.05). Cox regression analysis identified MI ≥ 66{\%} as the only independent predictor of DRS (P < 0.001, relative risk [RR] = 12.44), RFS (P < 0.001, RR = 8.67), and distant failure (P < 0.001, RR = 24.89). Only 2{\%} of patients with MI < 66{\%} had distant failure and died of the disease at 5 years, compared with a 29{\%} 5-year distant failure rate and a 22{\%} 5-year death rate among patients with MI ≥ 66{\%}. Conclusion. Stage I (negative nodes) endometrial cancer patients with MI ≥ 66{\%} are at significant risk for distant failure and death and should be considered candidates for new randomized trials of adjuvant systemic therapy.",
keywords = "Distant recurrence, Endometrial cancer, Lymphadenectomy, Myometrial invasion, Prognosis, Recurrence, Surgical staging",
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T1 - Surgical stage I endometrial cancer

T2 - Predictors of distant failure and death

AU - Mariani, Andrea

AU - Webb, Maurice J.

AU - Keeney, Gary

AU - Lesnick, Timothy G.

AU - Podratz, Karl C.

PY - 2002

Y1 - 2002

N2 - Objective. The objective was to analyze the effect of various histopathologic characteristics on prognosis in surgical stage I (node-negative) endometrial carcinoma. Methods. During a 10-year period, 229 patients with stage I epithelial (all subtypes) endometrial cancer had hysterectomy and node dissection. Mean number of nodes harvested was 16.2 pelvic and 5.7 paraaortic. Median follow-up was 83 months. Sixty-seven patients (29%) received adjuvant radiotherapy. Results. Five-year disease-related survival (DRS) was 95%, and 5-year relapse-free survival (RFS) 91%. We observed 7 (3%) isolated vaginal recurrences, 14 (6%) distant failures, and 1 (0.4%) simultaneous recurrence at both regional (pelvic sidewall) and distant sites. Only 1 of 7 patients (14%) with vaginal failure died of the disease (median follow-up of censored patients after failure was 110 months), compared with 10 of the 15 patients (67%) with distant failure. By univariate analysis, myometrial invasion (MI) ≥ 66%, nonendometrioid histology, lymphovascular invasion, absence of associated hyperplasia, and tumor diameter >2 cm were significant predictors of poor prognosis with distant failure (P ≤ 0.05). Cox regression analysis identified MI ≥ 66% as the only independent predictor of DRS (P < 0.001, relative risk [RR] = 12.44), RFS (P < 0.001, RR = 8.67), and distant failure (P < 0.001, RR = 24.89). Only 2% of patients with MI < 66% had distant failure and died of the disease at 5 years, compared with a 29% 5-year distant failure rate and a 22% 5-year death rate among patients with MI ≥ 66%. Conclusion. Stage I (negative nodes) endometrial cancer patients with MI ≥ 66% are at significant risk for distant failure and death and should be considered candidates for new randomized trials of adjuvant systemic therapy.

AB - Objective. The objective was to analyze the effect of various histopathologic characteristics on prognosis in surgical stage I (node-negative) endometrial carcinoma. Methods. During a 10-year period, 229 patients with stage I epithelial (all subtypes) endometrial cancer had hysterectomy and node dissection. Mean number of nodes harvested was 16.2 pelvic and 5.7 paraaortic. Median follow-up was 83 months. Sixty-seven patients (29%) received adjuvant radiotherapy. Results. Five-year disease-related survival (DRS) was 95%, and 5-year relapse-free survival (RFS) 91%. We observed 7 (3%) isolated vaginal recurrences, 14 (6%) distant failures, and 1 (0.4%) simultaneous recurrence at both regional (pelvic sidewall) and distant sites. Only 1 of 7 patients (14%) with vaginal failure died of the disease (median follow-up of censored patients after failure was 110 months), compared with 10 of the 15 patients (67%) with distant failure. By univariate analysis, myometrial invasion (MI) ≥ 66%, nonendometrioid histology, lymphovascular invasion, absence of associated hyperplasia, and tumor diameter >2 cm were significant predictors of poor prognosis with distant failure (P ≤ 0.05). Cox regression analysis identified MI ≥ 66% as the only independent predictor of DRS (P < 0.001, relative risk [RR] = 12.44), RFS (P < 0.001, RR = 8.67), and distant failure (P < 0.001, RR = 24.89). Only 2% of patients with MI < 66% had distant failure and died of the disease at 5 years, compared with a 29% 5-year distant failure rate and a 22% 5-year death rate among patients with MI ≥ 66%. Conclusion. Stage I (negative nodes) endometrial cancer patients with MI ≥ 66% are at significant risk for distant failure and death and should be considered candidates for new randomized trials of adjuvant systemic therapy.

KW - Distant recurrence

KW - Endometrial cancer

KW - Lymphadenectomy

KW - Myometrial invasion

KW - Prognosis

KW - Recurrence

KW - Surgical staging

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