Overall survival and disease-free survival in endometrial cancer: prognostic factors in 276 patients
Authors Tejerizo-García Á, Jiménez-López JS, Muñoz-González JL, Bartolomé-Sotillos S, Marqueta-Marqués L, López-González G, Gómez JFP
Received 14 July 2013
Accepted for publication 5 August 2013
Published 16 September 2013 Volume 2013:6 Pages 1305—1313
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Álvaro Tejerizo-García,1 Jesús S Jiménez-López,1 José L Muñoz-González,1 Sara Bartolomé-Sotillos,1 Laura Marqueta-Marqués,1 Gregorio López-González,1 José F Pérez-Regadera Gómez2
1Service of Obstetrics and Gynecology, 2Radiation Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
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, tumor grade, lymph-node involvement, tumor remnant, recurrence, myometrial invasion