Patterns of failures in endometrial cancer: clinicopathological variables predictive of the risk of local, distant and retroperitoneal failure

Abstract

The aim of this study was to assess the pattern of failure and the outcome of endometrial cancer patients and to analyze the variables predictive of the risk of local, distant and retroperitoneal lymph node disease recurrence.

Patients and methods: The authors assessed 511 patients who underwent primary surgery. The median follow-up of survivors was 74 months. Peritoneal, hematogenous and lymph node recurrences outside retroperitoneal area were considered as distant failures.

Results: Tumor relapsed in 83 (16.2%) patients. Median time to recurrence was 18.5 months (range, 3-129 months). The relapse was local in 13 cases, distant in 37, retroperitoneal in 22, and involved both distant and other sites in 11. Logistic regression showed that cervical involvement was the only independent predictor of local recurrence. Tumor grade, lymph-vascular space involvement (LVSI) and myometrial invasion were independent predictors of distant failure. Lymph node status and tumor grade were independent predictors of retroperitoneal recurrence. Five- and 10-year overall survival rates were 87.1% and 79.5%, respectively. Patient age, lymph node status, cervical involvement, tumor grade, LVSI and myometrial invasion were independent prognostic variables for overall survival.

Conclusion: Cervical involvement was an independent predictor of local recurrence, LVSI and myometrial invasion were independent predictors of distant failure, lymph node status was an independent predictor of retroperitoneal relapse, and tumor grade was an independent predictor of both distant and retroperitoneal recurrence. The identification of risk factors for different patterns of failure can be useful in better tailoring adjuvant treatment.