Overall survival and disease-free survival in endometrial cancer: prognostic factors in 276 patients

Abstract

Objective: The aim of the study reported here was to assess the disease-free survival and overall survival of patients with endometrial cancer and to determine independent factors affecting the prognosis.

Materials and methods: This was a retrospective study of a single-center clinical series of 276 patients (mean age 64 years) with histologically confirmed cancer of the corpus uteri. The standard treatments were extrafascial total hysterectomy and bilateral salpingo-oophorectomy with selective pelvic/para-aortic node dissection, according to risk for recurrence. Actuarial overall survival and disease-free survival were estimated according to the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards analyses were used to assess the prognostic significance of the different variables.

Results: The estimated median follow-up, determined using the inverse Kaplan-Meier method, was 45 months (95% confidence interval [CI] 41.2-48.8) for disease-free survival and 46 months (95% CI 43.0-49.0) for overall survival. The statistically significant variables affecting disease-free survival and overall survival were age, serous-papillary and clear-cell histological types, outer-half myometrial invasion, advanced International Federation of Gynecology and Obstetrics (FIGO) stage, tumor grades G2 and G3, incomplete surgical resection, positive lymph nodes, lymphovascular space invasion, tumor remnants of >1 cm after surgery, and high-risk group. In the multivariate Cox regression model, predictors of tumor recurrence included advanced FIGO stage (hazard ratio [HR] 4.90, 95% CI 2.57-9.36, P < 0.001) and tumor grades G2 (HR 4.79, 95% CI 1.73-13.27, P = 0.003) and G3 (HR 7.56, 95% CI 2.75-20.73, P < 0.001). The same variables were also associated with a significantly higher risk of tumor-related mortality.

Conclusion: FIGO stage and tumor grade were independent prognostic factors of disease-free survival and overall survival in endometrial cancer patients. Outcome was also influenced by histopathologic type, myometrial and lymphovascular space invasion, lymph-node involvement, age, and tumor remnants after surgery, although a larger study sample is probably needed to demonstrate the independent association of these variables with survival.

Keywords: FIGO stage; lymph-node involvement; myometrial invasion; recurrence; tumor grade; tumor remnant.

Figure 1

(A) Disease-free survival and (B) overall survival in the study population.

Figure 2

Differences in (A) disease-free survival and (B) overall survival between local and advanced International Federation of Gynecology and Obstetrics (FIGO) stages.

Figure 3

Differences in (A) disease-free survival and (B) overall survival according to tumor grade.