Analysis The Influential Factors Of Disease-Free Interval In Endometrial Carcinoma After Initial Surgery

ObjectiveBy analyzing the case data and follow-up results of patients with endometrial cancer,the influence of related clinical factors on the disease-free interval after operation of endometrial cancer was explored,providing reference for prolonging the disease-free interval and improving the prognosis of patients with endometrial cancer.MethodsIn this study,315 patients with endometrial cancer who visited gynecology department of Jiangsu Subei people’s hospital from January 2014 to January 2022 and underwent initial surgery were collected and followed up through the medical record system.The follow-up date ended in January 2023,excluding 8 patients lost,and according to the interval time from the end of surgery to the first recurrence of 3 0 7patients with endometrial cancer,To calculate the patient’s disease-free interval,Age of diagnosis,menopause or not,BMI,histological grade,ascites carcinomatology,fertility status,pathological type,first symptom,complications,history of abdominal benign surgery,preoperative endometrial thickness,preoperative uterine hyperecho,depth of muscular infiltration,preoperative tumor markers(CA125,CA199,CEA,HE4),and endometrial biopsy were analyzed Surgical treatment interval,surgical method,surgical resection scope,clinical(FIGO)staging,lymphovascular space involvement,adnexal metastasis,cervical invasion,pathological immunohistochemistry(ER,PR,Ki67,P53),gynecological benign disease,Effect of adjuvant therapy(radiotherapy,chemotherapy or combination therapy)on disease-free interval after surgery for endometrial cancer.Results1.Single factor analysis was carried out by Log-Rank method and Kaplan-Meier survival analysis curve was drawn.The results showed that:(1)Age ≥54 years old,postmenopausal,diabetes mellitus,unexcised lymph nodes,stage III-IV(FIGO stage),G2-G3 grade,non-endometrioid carcinoma,depth of muscular invasion ≥ 1/2 layer,cancer cells found in ascites,Ki67 positive expression,and no adjuvant therapy after surgery are risk factors for the reduced disease-free interval of patients with endometrial cancer after surgery(P<0.05),the difference was statistically significant;(2)BMI,fertility history,initial symptoms,whether hypertension was present,history of abdominal benign surgery,preoperative endometrial thickness,preoperative uterine hyperecho,endometrial sampling biopsy to surgical treatment interval,preoperative CA125 level,preoperative CA199 level,preoperative CEA level,preoperative HE4 level,surgical method,lymphatic vasculature space involvement,and adrenal metastasis Metastasis,cervical invasion,lymph node metastasis,ER,PR,P5 3expression,and gynecological benign disease were not correlated with postoperative disease-free interval of endometrial cancer,and the difference was not statistically significant(P≥0.05).2.The results of multi-factor analysis with COX risk regression model show that:(1)Menopause,cancer cells found in ascites,unresected lymph nodes,G2-G3 grade,Ki6 7 positive expression,and diabetes mellitus were independent risk factors affecting postoperative disease-free interval of patients with endometrial cancer(P<0.05).(2)Non-endometrioid cancer patients with higher histological grade,diabetes,positive Ki67 expression,no lymph nodes removed after surgery,cancer cells found in ascites,and postmenopausal patients with non-endometrioid cancer had shorter postoperative disease-free interval and higher recurrence rate;However,non-menopausal patients with endometrioid cancer,no diabetes mellitus,negative Ki67 expression,good differentiation,resection of lymph nodes during surgery,and no cancer cells in ascites had a prolonged postoperative disease-free interval and a low recurrence rate.3.ROC curve evaluated the value of various influencing factors in predicting postoperative recurrence of endometrial cancer,which showed that:(1)History of diabetes,lymph node resection,FIGO stage,pathological type,depth of muscle infiltration,lympho-vascular space involvement were significantly effective in predicting and evaluating postoperative recurrence of endometrial cancer(P=0.000).The value of preoperative HE4 level and ascites carcinomatology in predicting postoperative recurrence of endometrial cancer was higher(P=0.001).Menopause(P=0.013),cervical invasion(P=0.016),attachment metastasis(P=0.044)and P53 expression(P=0.017)also had statistical significance in predicting postoperative recurrence of endometrial cancer,but the value was not high.(2)Age,BMI,reproductive history,initial symptoms,combined hypertension,history of benign abdominal surgery,preoperative endometrial thickness,preoperative uterine hyperecho,preoperative CA199 level,preoperative CA125 level,preoperative CEA level,endometrial sampling biopsy to surgical treatment interval,surgical method,histological grade,ER expression,PR expression,Ki67 There were no significant differences in the prediction of postoperative recurrence of endometrial cancer(P>0.05).Conclusions1.Menopause,diabetes mellitus,cancer cells found in ascites,unresected lymph nodes,Ki67 positive immunohistochemical expression,G2-G3 grade,and non-endometrioid cancer are independent risk factors affecting disease-free interval after surgery for endometrial cancer.These patients have a high recurrence risk,a high recurrence rate,and a short disease-free interval after surgery.2.The factors with high predictive efficacy for postoperative recurrence in EC patients are: diabetes history,lymph node resection,FIGO stage,pathological type,depth of muscular infiltration,and lymphovascular space involvement.Ascites carcinomatology,preoperative HE4 level can also be used as predictors of postoperative recurrence of endometrial cancer.3.In order to reduce the postoperative recurrence rate of patients with endometrial cancer,prolong the survival time before recurrence and improve the quality of life,factors affecting the disease-free interval time after endometrial cancer should be considered in clinical treatment,and a reasonable treatment plan should be developed.