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Published online: 2021-05-14
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Why do some patients with stage 1A and 1B endometrial endometrioid carcinoma experience recurrence? A retrospective study in search of prognostic factors

Birol Ocak1, Ahmet Bilgehan Sahin1, Fatma Oz Atalay2, Mine Ozsen2, Bahar Dakiki3, Seray Ture3, Seda Sali1, Ozgur Tanriverdi4, Mehmet Bayrak5, Hakan Ozan5, Candan Demiroz Abakay6, Adem Deligonul1, Erdem Cubukcu1, Turkkan Evrensel1
DOI: 10.5603/GP.a2021.0093
·
Pubmed: 34105738
Affiliations
  1. Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
  2. Department of Surgical Pathology, Faculty of Medicine, Uludag University, Bursa, Turkey
  3. Department of Internal Medicine, Faculty of Medicine, Uludag University, Bursa, Turkey
  4. Department of Medical Oncology, Faculty of Medicine, Sitki Kocman University, Mugla, Turkey
  5. Department of Gynecologic Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
  6. Department of Radiation Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey

open access

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ORIGINAL PAPERS Gynecology
Published online: 2021-05-14

Abstract

Objectives: Endometrial endometrioid carcinoma (EEC) is the most encountered subtype of endometrial cancer (EC). Our study aimed to investigate the factors affecting recurrence in patients with stage 1A and 1B EEC.

Material and methods: Our study included 284 patients diagnosed with the International Federation of Gynecology and Obstetrics stage 1A/1B EEC in our center from 2010 to 2018. The clinicopathological characteristics of the patients were obtained retrospectively from their electronic files.

Results: The median age of the patients was 60 years (range 31–89). The median follow-up time of the patients was 63.6 months (range 3.3–185.6). Twenty-two (7.74%) patients relapsed during follow-up. Among the relapsed patients, 59.1% were at stage 1A ECC, and 40.9% were at stage 1B. In our study, the one-, three-, and five-year recurrence-free survival (RFS) rates were 98.9%, 95.4%, and 92.9%, respectively. In the multivariate analysis, grade and tumor size were found to be independent parameters of RFS in all stage 1 EEC patients. Furthermore, the Ki-67 index was found to affect RFS in stage 1A EEC patients, and tumor grade affected RFS in stage 1B EEC patients. In the time-dependent receiver operating characteristic curve analysis, the statistically significant cut-off values were determined for tumor size and Ki-67 index in stage 1 EEC patients.

Conclusions: Stage 1-EEC patients in the higher risk group in terms of tumor size, Ki-67, and grade should be closely monitored for recurrence. Defining the prognostic factors for recurrence in stage 1 EEC patients may lead to changes in follow-up algorithms.

Abstract

Objectives: Endometrial endometrioid carcinoma (EEC) is the most encountered subtype of endometrial cancer (EC). Our study aimed to investigate the factors affecting recurrence in patients with stage 1A and 1B EEC.

Material and methods: Our study included 284 patients diagnosed with the International Federation of Gynecology and Obstetrics stage 1A/1B EEC in our center from 2010 to 2018. The clinicopathological characteristics of the patients were obtained retrospectively from their electronic files.

Results: The median age of the patients was 60 years (range 31–89). The median follow-up time of the patients was 63.6 months (range 3.3–185.6). Twenty-two (7.74%) patients relapsed during follow-up. Among the relapsed patients, 59.1% were at stage 1A ECC, and 40.9% were at stage 1B. In our study, the one-, three-, and five-year recurrence-free survival (RFS) rates were 98.9%, 95.4%, and 92.9%, respectively. In the multivariate analysis, grade and tumor size were found to be independent parameters of RFS in all stage 1 EEC patients. Furthermore, the Ki-67 index was found to affect RFS in stage 1A EEC patients, and tumor grade affected RFS in stage 1B EEC patients. In the time-dependent receiver operating characteristic curve analysis, the statistically significant cut-off values were determined for tumor size and Ki-67 index in stage 1 EEC patients.

Conclusions: Stage 1-EEC patients in the higher risk group in terms of tumor size, Ki-67, and grade should be closely monitored for recurrence. Defining the prognostic factors for recurrence in stage 1 EEC patients may lead to changes in follow-up algorithms.

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Keywords

endometrial endometrioid carcinoma; early stage; recurrence-free survival; ki-67; grade; tumor size

About this article
Title

Why do some patients with stage 1A and 1B endometrial endometrioid carcinoma experience recurrence? A retrospective study in search of prognostic factors

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2021-05-14

DOI

10.5603/GP.a2021.0093

Pubmed

34105738

Keywords

endometrial endometrioid carcinoma
early stage
recurrence-free survival
ki-67
grade
tumor size

Authors

Birol Ocak
Ahmet Bilgehan Sahin
Fatma Oz Atalay
Mine Ozsen
Bahar Dakiki
Seray Ture
Seda Sali
Ozgur Tanriverdi
Mehmet Bayrak
Hakan Ozan
Candan Demiroz Abakay
Adem Deligonul
Erdem Cubukcu
Turkkan Evrensel

References (25)
  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
  2. Van den Bosch T, Coosemans An, Morina M, et al. Screening for uterine tumours. Best Pract Res Clin Obstet Gynaecol. 2012; 26(2): 257–266.
  3. Kitchener HC, Trimble EL. Endometrial Cancer Working Group of the Gynecologic Cancer Intergroup. Endometrial cancer state of the science meeting. Int J Gynecol Cancer. 2009; 19(1): 134–140.
  4. Dinkelspiel HE, Wright JD, Lewin SN, et al. Contemporary clinical management of endometrial cancer. Obstet Gynecol Int. 2013; 2013: 583891.
  5. Obermair A, Youlden DR, Young JP, et al. Risk of endometrial cancer for women diagnosed with HNPCC-related colorectal carcinoma. Int J Cancer. 2010; 127(11): 2678–2684.
  6. Seebacher V, Schmid M, Polterauer S, et al. The presence of postmenopausal bleeding as prognostic parameter in patients with endometrial cancer: a retrospective multi-center study. BMC Cancer. 2009; 9: 460.
  7. Felix AS, Weissfeld JL, Stone RA, et al. Factors associated with Type I and Type II endometrial cancer. Cancer Causes Control. 2010; 21(11): 1851–1856.
  8. Kurman R, Carcangiu M, Herrington C, et al. WHO classification of tumours of female reproductive organs International Agency for Research on Cancer. World Health Organization Lyon: International Agency for Research on Cancer. 2014: 126–128.
  9. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009; 105(2): 103–104.
  10. National Comprehensive Cancer Network. Uterine Neoplasms, Version 1.2021. https://www.nccn.org/professionals /physician_gls/pdf/uterine.pdf (2021.01.10).
  11. Sorbe B. Predictive and prognostic factors in definition of risk groups in endometrial carcinoma. ISRN Obstet Gynecol. 2012; 2012: 325790.
  12. Huijgens ANJ, Mertens HJ. Factors predicting recurrent endometrial cancer. Facts Views Vis Obgyn. 2013; 5(3): 179–186.
  13. Kaewpangchan P, Cheewakriangkrai C. Relapse patterns and outcomes following recurrence of endometrial cancer in northern Thai women. Asian Pac J Cancer Prev. 2015; 16(9): 3861–3866.
  14. Ayık Aydın H, Erdoğan G, Pestereli HE, et al. Role of less commonly agreed risk factors on disease recurrence in endometrial cancer: a propensity scorematched comparison. Turk J Obstet Gynecol. 2019; 16(1): 55–62.
  15. Ayhan A, Tuncer Z, Tuncer R, et al. Risk factors for recurrence in clinically early endometrial carcinoma: an analysis of 183 consecutive cases. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1994; 57(3): 167–170.
  16. Akar S, Harmankaya I, Celik C. Prognostic significance of tumor grade in early-stage endometrioid endometrial cancer. Annals of Medical Research. 2019; 26(9): 1777.
  17. Jeppesen MM, Jensen PT, Gilså Hansen D, et al. The nature of early-stage endometrial cancer recurrence-A national cohort study. Eur J Cancer. 2016; 69: 51–60.
  18. Han KH, Kim HS, Lee M, et al. Prognostic factors for tumor recurrence in endometrioid endometrial cancer stages IA and IB. Medicine (Baltimore). 2017; 96(21): e6976.
  19. Çakır C, Kılıç İÇ, Yüksel D, et al. Does tumor size have prognostic value in patients undergoing lymphadenectomy in endometrioid-type endometrial cancer confined to the uterine corpus? Turk J Med Sci. 2019; 49(5): 1403–1410.
  20. Schink J, Miller D, Lurain J, et al. Tumor size in endometrial cancer. Cancer. 1991; 67(11): 2791–2794, doi: 10.1002/1097-0142(19910601)67:11<2791::aid-cncr2820671113>3.0.co;2-s.
  21. Scholzen T, Gerdes J. The Ki-67 protein: From the known and the unknown. Journal of Cellular Physiology. 2000; 182(3): 311–322, doi: 10.1002/(sici)1097-4652(200003)182:3<311::aid-jcp1>3.0.co;2-9.
  22. National Comprehensive Cancer Network. Breast Cancer, Version 6.2020. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf (2020.10.15).
  23. National Comprehensive Cancer Network. Neuroendocrine and Adrenal Tumors, Version 2.2020. https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine. pdf (2020.10.15).
  24. Kitson S, Sivalingam VN, Bolton J, et al. Ki-67 in endometrial cancer: scoring optimization and prognostic relevance for window studies. Mod Pathol. 2017; 30(3): 459–468.
  25. Yu CG, Jiang XY, Li B, et al. Expression of ER, PR, C-erbB-2 and Ki-67 in Endometrial Carcinoma and their Relationships with the Clinicopathological Features. Asian Pac J Cancer Prev. 2015; 16(15): 6789–6794.

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