Prognostic Factors Of Recurrent Stage ? Endometrial Cancer

Background:In recent years,the incidence of endometrial cancer has increased year by year.In China,endometrial cancer has become the second largest malignant tumor of female reproductive system.The overall prognosis of patients with stage I endometrial cancer is good,with a low recurrence rate,but a high mortality rate.At present,the survival prognostic factors of patients with recurrent stage I endometrial cancer have not been fully elucidated.Objective:To explore the prognostic factors of patients with recurrent stage I endometrial cancer,and to provide a basis for clinical evaluation of these patients.Methods:The clinical data of patients with stage I endometrial cancer diagnosed and treated at Qilu Hospital of Shandong University from January 1,2005 to December 31,2017 were collected,and the patients who relapsed after the initial treatment were selected as the enrolled subjects.The relationship between various factors,such as age,menopausal status,comorbidities(hypertension,diabetes),surgical path,scope of hysterectomy,pelvic lymph nodes,para-aortic lymph.nodes and omentum resection,pathological type,Bokhman classification,differentiation degree of primary tumor,primary tumor size,depth of muscular invasion,risk group,molecular markers(ER,PR,P53,Ki-67),postoperative adjuvant therapy,recurrence site,recurrence interval,and overall survival following relapse(OSFR)was analyzed.Take the survival analysis by Kaplan-Meler to calculate the 3-year OSFR rate of patients with recurrent endometrial cancer and draw a survival curve,using log-rank method to conduct univariate analysis to indentify the prognostic factors.Then the statistically significant indicators were took into the univariate analysis and COX regression model was used to analyze the independent risk factors affecting the prognosis of recurrent patients.P<0.05 was considered statistically significant.Results:A total of 28 patients with recurrent stage I endometrial cancer were included.The median relapse interval of the included patients was 28.5 months(5-59 months).46.43%(n=13)of the recurrences occurred within 2 years after surgery.53.57%(n=15)relapses occurred within 3 years after surgery,and all relapses occurred within 5 years after surgery.The sites of recurrence include the vagina,lymph nodes,peritoneum,liver,lungs,bones,and mediastinum.64.29%of the recurrences were extra-pelvic recurrences.The 3-year cumulative OSFR rate of the included patients was 17.9%,and the 5-year cumulative OSFR rate was 8.9%.Univariate analysis showed that the prognosis of patients with recurrent stage I endometrial cancer may be related to age,hypertension,menopausal status,tumor differentiation,pathological type,Bokhman classification,primary tumor size,risk group,recurrence site,Multivariate analysis showed that extra-pelvic recurrence were independent risk factors affecting the prognosis of patients with recurrent stage I endometrial cancer.The risk of death of patients with extra-pelvic recurrence is nearly 4 times that of patients with pelvic relapse(HR=3.971 95%CI 1.049-15.037).Conclusions:1.Age,hypertension,menopausal status,differentiation degree of tumor tissue,pathological type,Bokhman classification,primary tumor size,risk group and recurrence site have an impact on the prognosis of patients with recurrent stage I endometrial cancer.2.Extra-pelvic recurrence is independent risk factors for the prognosis of patients with recurrent stage I endometrial cancer.3.For the high-risk group of stage I endometrial cancer patients,the postoperative adjuvant therapy has no obvious effect on the prognosis after its recurrence.