TY - JOUR
T1 - Endometrioid uterine cancer
T2 - Histopathological risk factors of local and distant recurrence
AU - Fujimoto, Toshio
AU - Nanjyo, Hiroshi
AU - Fukuda, Jun
AU - Nakamura, Akira
AU - Mizunuma, Hideki
AU - Yaegashi, Nobuo
AU - Sugiyama, Toru
AU - Kurachi, Hirohisa
AU - Sato, Akira
AU - Tanaka, Toshinobu
PY - 2009/2
Y1 - 2009/2
N2 - Objectives: To determine the relationship between histopathological prognostic factors and sites of initial recurrence in endometrioid uterine cancer. Methods: A total of 355 patients (Stage I, n = 227; II, n = 38; III, n = 90) underwent primary radical surgery including complete systematic pelvic lymph node (PLN) and para-aortic lymph node (PALN) adenectomy followed by adjuvant chemotherapy who were at risk for recurrence. Relapse-free survival (RFS) and disease-related survival (DRS) were analyzed using the log-rank testing. Multivariate Cox regression analysis and logistic regression analysis were used to determine and estimate independent prognostic factors. Results: Lymph-vascular space invasion (LVSI), architectural grade (AG), myometrial invasion, and PLN metastasis (PLNM) were identified as independent prognostic factors for RFS. AG (p = 0.0043) related with local recurrence. Among patients who received adjuvant chemotherapy, patients with G3 tumor had higher ratio of recurrence (16/45) compared with G1/2 tumor (11/102) (p = 0.0004). Meanwhile, PLNM related with distant recurrence (p = 0.0008). There was a statistically significant difference in RFS according to the number of positive PLN sites (group 0: n = 313, 1: n = 16, ≥ 2: n = 26), five-year RFS in each group was 91.9%, 81.3%, and 41.2%, respectively. Conclusions: Sites of initial recurrence were related with AG and PLNM in patients with endometrioid uterine cancer. Current chemotherapy alone may not be an effective adjuvant therapy to prevent recurrence in patients with G3 tumor and ≥ 2 positive PLN sites. Prospective clinical trial needs to be conducted to establish the strategy of adjuvant therapy with these patients.
AB - Objectives: To determine the relationship between histopathological prognostic factors and sites of initial recurrence in endometrioid uterine cancer. Methods: A total of 355 patients (Stage I, n = 227; II, n = 38; III, n = 90) underwent primary radical surgery including complete systematic pelvic lymph node (PLN) and para-aortic lymph node (PALN) adenectomy followed by adjuvant chemotherapy who were at risk for recurrence. Relapse-free survival (RFS) and disease-related survival (DRS) were analyzed using the log-rank testing. Multivariate Cox regression analysis and logistic regression analysis were used to determine and estimate independent prognostic factors. Results: Lymph-vascular space invasion (LVSI), architectural grade (AG), myometrial invasion, and PLN metastasis (PLNM) were identified as independent prognostic factors for RFS. AG (p = 0.0043) related with local recurrence. Among patients who received adjuvant chemotherapy, patients with G3 tumor had higher ratio of recurrence (16/45) compared with G1/2 tumor (11/102) (p = 0.0004). Meanwhile, PLNM related with distant recurrence (p = 0.0008). There was a statistically significant difference in RFS according to the number of positive PLN sites (group 0: n = 313, 1: n = 16, ≥ 2: n = 26), five-year RFS in each group was 91.9%, 81.3%, and 41.2%, respectively. Conclusions: Sites of initial recurrence were related with AG and PLNM in patients with endometrioid uterine cancer. Current chemotherapy alone may not be an effective adjuvant therapy to prevent recurrence in patients with G3 tumor and ≥ 2 positive PLN sites. Prospective clinical trial needs to be conducted to establish the strategy of adjuvant therapy with these patients.
KW - Adjuvant chemotherapy
KW - Architectural grade
KW - Distant recurrence
KW - Endometrioid uterine cancer
KW - Local recurrence
KW - Pelvic lymph node metastasis
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U2 - 10.1016/j.ygyno.2008.10.019
DO - 10.1016/j.ygyno.2008.10.019
M3 - Article
C2 - 19062082
AN - SCOPUS:58149483516
VL - 112
SP - 342
EP - 347
JO - Gynecologic Oncology
JF - Gynecologic Oncology
SN - 0090-8258
IS - 2
ER -