Long-term Survival Outcomes of Early-stage Grade 1 and 2 EndometrioidType Endometrial Cancer Patients

Year 2023, , 232 - 238, 30.04.2023

Fazıl Avcı , Orhan Önder Eren , Ahmet Bilgi , Hamit Başaran , Murat Celik , Melek Caglayan , Cetin Celik

https://doi.org/10.54005/geneltip.1265954

Abstract

Aims: Early-stage endometrioid-type endometrial cancer (EC) has a favorable prognosis. The recurrence is still the biggest issue. There are differences in the literature in terms of treatment modalities in early-stage. We investigated long-term survival outcomes of early-stage grade 1 and 2 endometrioid-type EC patients.
Methods: Out of 327 cases, 294 cases in stage 1 and 33 cases in stage 2 were evaluated. Age, stage, tumor size, histologic grade, degree of myometrial invasion, presence of lymphovascular invasion (LVSI), peritoneal cytology positive, presence of recurrence, overall survival (OS), and disease-free survival (DFS) between two groups were evaluated statistically.
Results: The mean age of 327 patients was 64.0±10.0 years. Out of 327, 65.7% were ≥60 years, 90% were stage 1, 74.6% were grade 1, 1.8% had positive peritoneal cytology, 8.3% had LVSI and 86% had ≤50% myometrial invasion. Recurrence was detected in 6.4% of patients. 40.7% of patients received adjuvant radiotherapy. Only the adjuvant radiotherapy was found a significant association between two groups. Only presence of recurrence in terms of OS and DFS durations was a significant parameter in the regression analysis.
Conclusions: Development of recurrence in early-stage endometrioid-type EC is the main prognostic predictor for survival. The early diagnosis and treatment of recurrence have a positive impact on the prognosis.

Keywords

endometrial cancer, endometrioid type, recurrence, survival

Supporting Institution

None

Project Number

None

Thanks

None

Erken Evre Grade 1 ve 2 Endometrioid Tip Endometrium Kanseri Tanılı Olgularda Uzun Dönem Sonuçları

Abstract

Özet
Amaç: Erken evre endometrioid tipi endometrial kanser (EC) iyi bir prognoza sahiptir. rekürrens hala en büyük sorundur. Literatürde erken evrede tedavi yöntemleri açısından farklılıklar vardır. Erken evre grade 1 ve 2 endometrioid tip endometriyum kanseri tanılı olgularda uzun dönem sonuçlarını retrospektif olarak araştırmaktır.
Method: toplam 327 olgudan evre 1’de 294 olgu ve evre 2’de 33 olgu değerlendirildi. İki grup arasında yaş, evre, tümör çapı, grade, myometrial invazyon derecesi, lenfovasküler invazyon (LVSI) varlığı, periton sitolojisi pozitifliği, rekürrens varlığı, genel sağkalım (OS) ve hastalıksız sağkalım (DFS) süreleri istatistiki olarak değerlendirildi.
Bulgular: Toplam 327 olgunun yaş ortalaması 64,0±10,0 yıl olrak hesaplandı. 327 olgudan 60 yaş ve üstü olgular %65,7, olguların %90’ı evre 1 ve %74,6’sı grade 1, periton sitolojisi %1,8 oranında pozitif, ve LVSI varlığı %8,3’ünde pozitif, ve %50’den az myometrial invazyon olguların %86,5’inde saptandı. Rekürrens, olguların %6,4’ünde saptandı. Olgulara adjuvan radyoterapi %40,7 oranında uygulandı. Olgular evre 1 ve evre 2 olarak karşılaştırıldığında sadece adjuvan radyoterapi tedavisi açısından anlamlı fark saptandı. OS ve DFS süreleri açısından regresyon analizinde sadece rekürrens varlığı anlamlı faktör olarak saptandı.
Sonuç: Endometrioit tip endometrium kanserinde rekürrens gelişmesi sürvi açısından en önemli prognostik faktördür. Rekürrensin erken tanı ve tedavisi ile prognoz olumlu yönde etkilenmektedir.

Keywords

endometrioid, endometriyal kanser, rekürrens, survi

Project Number

None

References

• Siegel RL MK, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020 Jan;70(1):7-30. .
• Tung HJ, Huang HJ, Lai CH. Adjuvant and post-surgical treatment in endometrial cancer. Best Pract Res Clin Obstet Gynaecol. 2022 Jan;78:52-63.
• Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249.
• McDonald ME, Bender DP. Endometrial Cancer: Obesity, Genetics, and Targeted Agents. Obstet Gynecol Clin North Am. 2019 Mar;46(1):89-105. .
• Creasman WT, Odicino F, Maisonneuve P, Quinn MA, Beller U, Benedet JL et al. Carcinoma of the corpus uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006 Nov;95 Suppl 1:S105-43. .
• Colombo N, Preti E, Landoni F, Carinelli S, Colombo A, Marini C et al. ESMO Guidelines Working Group. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013 Oct;24 Suppl 6:vi33-8. .
• Connor EV, Rose PG. Management Strategies for Recurrent Endometrial Cancer. Expert Rev Anticancer Ther. 2018 Sep;18(9):873-885. .
• Scholten AN, van Putten WL, Beerman H, Smit VT, Koper PC, Lybeert ML et al. PORTEC Study Group. Postoperative radiotherapy for Stage 1 endometrial carcinoma: long-term outcome of the randomized PORTEC trial with central pathology review. Int J Radiat Oncol Biol Phys. 2005 Nov 1;63(3):834-8. .
• Nugent EK, Bishop EA, Mathews CA, Moxley KM, Tenney M, Mannel RS et al. Do uterine risk factors or lymph node metastasis more significantly affect recurrence in patients with endometrioid adenocarcinoma? Gynecol Oncol. 2012 Apr;125(1):94-8. .
• Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD et al. Gynecologic Oncology Group. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004 Mar;92(3):744-51. .
• Francis SR, Ager BJ, Do OA, Huang YJ, Soisson AP, Dodson MK et al. Recurrent early stage endometrial cancer: Patterns of recurrence and results of salvage therapy. Gynecol Oncol. 2019 Jul;154(1):38-44.
• Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC et al. PORTEC Study Group. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol. 2003 May;89(2):201-9.
• Wortman BG, Nout RA, Bosse T, Creutzberg CL. Selecting Adjuvant Treatment for Endometrial Carcinoma Using Molecular Risk Factors. Curr Oncol Rep. 2019 Jul 31;21(9):83. .
• Fung-Kee-Fung M, Dodge J, Elit L, Lukka H, Chambers A, Oliver T. Cancer Care Ontario Program in Evidence-based Care Gynecology Cancer Disease Site Group. Follow-up after primary therapy for endometrial cancer: a systematic review. Gynecol Oncol. 2006 Jun;101(3):520-9. .
• Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021 Jan;31(1):12-39.
• Bendifallah S, Ouldamer L, Lavoue V, Canlorbe G, Raimond E, Coutant C et al.. Groupe de Recherche FRANCOGYN. Patterns of recurrence and outcomes in surgically treated women with endometrial cancer according to ESMO-ESGO-ESTRO Consensus Conference risk groups: Results from the FRANCOGYN study Group. Gynecol Oncol. 2017 Jan;144(1):107-112.
• Nomura H, Aoki D, Susumu N, Mizuno M, Nakai H, Arai M et al. Analysis of the relapse patterns and risk factors of endometrial cancer following postoperative adjuvant chemotherapy in a phase III randomized clinical trial. Gynecol Oncol. 2019 Dec;155(3):413-419.
• Dabi Y, Uzan J, Bendifallah S, Ouldamer L, Lavoué V, Canlorbe G et al. Groupe de Recherche FRANCOGYN. Prognostic value of local relapse for patients with endometrial cancer. Eur J Surg Oncol. 2017 Nov;43(11):2143-2149.
• Pecorelli S. Revised FIGO staging for carcinoma of the vulva c, and endometrium. Int J Gynaecol Obstet. 2009 May;105(2):103-4. doi: 10.1016/j.ijgo.2009.02.012. Erratum in: Int J Gynaecol Obstet. 2010 Feb;108(2):176.
• Abu-Rustum NR, Yashar CM, Bradley K, Campos SM, Chino J, Chon HS et al. NCCN Guidelines® Insights: Uterine Neoplasms, Version 3.2021. J Natl Compr Canc Netw. 2021 Aug 1;19(8):888-895.
• Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J et al. ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol. 2016 Jan;27(1):16-41. doi: 10.1093/annonc/mdv484. Epub 2015 Dec 2. Erratum in: Ann Oncol. 2017 Jul 1;28(suppl_4):iv167-iv168. PMID: 26634381.
• Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR et al. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018 Feb;16(2):170-199.
• Nout RA, Smit VT, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LC et al. PORTEC Study Group. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010 Mar 6;375(9717):816-23.
• Han KH, Kim HS, Lee M, Chung HH, Song YS. Prognostic factors for tumor recurrence in endometrioid endometrial cancer stages IA and IB. Medicine (Baltimore). 2017 May;96(21):e6976. .
• Jin M, Hou X, Sun X, Zhang Y, Hu K, Zhang F. Impact of different adjuvant radiotherapy modalities on women with early-stage intermediate- to high-risk endometrial cancer. Int J Gynecol Cancer. 2019 Oct;29(8):1264-1270.
• Imboden S, Tapia C, Scheiwiller N, Kocbek V, Altermatt HJ, Janzen J et al. Early-stage endometrial cancer, CTNNB1 mutations, and the relation between lymphovascular space invasion and recurrence. Acta Obstet Gynecol Scand. 2020 Feb;99(2):196-203. .
• Ocak B, Sahin AB, Oz Atalay F, Ozsen M, Dakiki B, Ture S et al. Why do some patients with stage 1A and 1B endometrial endometrioid carcinoma experience recurrence? A retrospective study in search of prognostic factors. Ginekol Pol. 2021 Jun 9.
• Ren K, Wang W, Sun S, Hou X, Hu K, Zhang F. Recurrent patterns after postoperative radiotherapy for early stage endometrial cancer: A competing risk analysis model. Cancer Med. 2022 Jan;11(1):257-267. .
• Dou Y, Song K, Fu Y, Shen Y, Zhang C, Yao S et al. Chinese Endometrial Carcinoma Consortium (CECC). Risk Factors and Prognosis of Early Recurrence in Stage I-II Endometrial Cancer: A Large-Scale, Multi-Center, and Retrospective Study. Front Med (Lausanne). 2022 Apr 14;9:808037. .
• Matsuo K, Matsuzaki S, Nusbaum DJ, Machida H, Nagase Y, Grubbs BH et al. Malignant peritoneal cytology and decreased survival of women with stage I endometrioid endometrial cancer. Eur J Cancer. 2020 Jul;133:33-46.
• Dai Y, Dong Y, Cheng Y, Hou H, Wang J, Wang Z et al. Prognostic significance of lymphovascular space invasion in patients with endometrioid endometrial cancer: a retrospective study from a single center. J Gynecol Oncol. 2020 May;31(3):e27. .
• Todo Y, Kato H, Okamoto K, Minobe S, Yamashiro K, Sakuragi N. Isolated tumor cells and micrometastases in regional lymph nodes in stage I to II endometrial cancer. J Gynecol Oncol. 2016 Jan;27(1):e1. .
• Chodavadia PA, Jacobs CD, Wang F, Havrilesky LJ, Chino JP, Suneja G. Off-study utilization of experimental therapies: Analysis of GOG249-eligible cohorts using real world data. Gynecol Oncol. 2020 Jan;156(1):154-161.
• Klopp A, Smith BD, Alektiar K, Cabrera A, Damato AL, Erickson B et al. The role of postoperative radiation therapy for endometrial cancer: Executive summary of an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol. 2014 May-Jun;4(3):137-144. .
• Stelloo E, Nout RA, Osse EM, Jürgenliemk-Schulz IJ, Jobsen JJ, Lutgens LC et al. Improved Risk Assessment by Integrating Molecular and Clinicopathological Factors in Early-stage Endometrial Cancer-Combined Analysis of the PORTEC Cohorts. Clin Cancer Res. 2016 Aug 15;22(16):4215-24. .
• Wortman BG, Nout RA, Bosse T, Creutzberg CL. Selecting Adjuvant Treatment for Endometrial Carcinoma Using Molecular Risk Factors. Curr Oncol Rep. 2019 Jul 31;21(9):83.