Analysis Of 702 Cases Of Early(stage ?~?)endometrial Cancer Recurrence And Related Treatment Factors After Recurrence

Objective: The purpose of this study is to study the recurrence-related factors and prognosis of early endometrial cancer(stage ~ ? ?).Methods: From January 2011 to December 2014,the fourth hospital of Hebei Medical University was selected for endometrial cancer surgery(laparoscopic/open extrafascial total hysterectomy with double attachments+/-pelvic lymphadenectomy+/-abdominal paraaortic lymphadenectomy+/-omentum resection)due to endometrial malignant tumors.The postoperative pathology was in accordance with FIGO 2009(International Federation of Obstetrics and Gynecology)standard.821 patients with stage I and stage II were followed up for 5-8 years,746 patients were followed up,702 patients with early endometrial cancer were concluded as research objects,and exclusion criteria were: 1)endometrial cancer was not the only malignant tumor(20 cases);2)Patients with incomplete follow-up data(24 cases)were retrospectively analyzed for patients who had completed the follow-up and met the target.The diagnostic criteria for recurrence are confirmed by imaging or histology during postoperative follow-up.The effects of 25 variables on postoperative recurrence and recurrence prognosis were observed and analyzed,including onset age,height,weight,history of hypertension,history of diabetes mellitus,operation mode,operation pathological stage,pathological type,pathological differentiation level,myometrial invasion depth,tumor location and size,ER expression,PR expression,KI67 expression,P53 expression,vascular metastasis,pregnancy history,abortion frequency,menopause,blood transfusion during operation,preoperative serum CA125 level,postoperative radiotherapy(external radiotherapy or/and vaginal brachytherapy),postoperative chemotherapy(?3 times/> 3 times),and post-relapse treatment.Logistic multivariate regression was used to analyze the related factors of disease recurrence and COX multivariate regression was used to analyze the related factors of prognosis after recurrence.Results:1.Among the 821 patients,702 completed the follow-up and were the subjects of this study,with a follow-up rate of 85.51%.Among them,49 patients relapsed(38 in stage I and 11 in stage II),with a recurrence rate of 6.98%.2.univariate analysis showed that recurrence-related risk factors included age(Z=-3.357,P=0.001),pathological differentiation grade(Z=-3.771,P < 0.001),tumor size(Z=-2.069,P=0.039),P53(Z=-5.002,P < 0.001),KI67(Z=-3.116,P=0.02),postoperative chemotherapy(Z=-3.343,P=0.01),intraop ERative blood transfusion(?~2=5.040,P=0.025),myometrial invasion depth(?~2=6.606,P=0.010),PR(?~2=8.851,P=0.003),vascular tumor thrombus(?~2=14.443,P < 0.001),er negative(?~2=55.063,P < 0.001).Univariate analysis showed that the prognostic factors after relapse included age(t=-3.695,P=0.001),menopause(?~2=4.678,P=0.031),and post-relapse treatment(?~2=11.934,P=0.015).Logistic multivariate regression analysis found that independent risk factors for postoperative recurrence included age [OR=1.045,95%CI=1.000-1.092,P=0.049],pathological differentiation level [OR=1.673,95%CI=1.148-2.438,P=0.007],P53[OR= 1.518,95%CI=1.181-1.951,P = 0.001),vascular tumor thrombus [OR=3.261,95%CI=1.177-9.036,P=0.023],ER negative [OR=0.198,95%CI=0.070-0.556,P=0.002].Multivariate COX regression analysis showed that the independent risk factors for the prognosis of relapsed patients included age [OR=1.074,95%CI=1.024-1.127,P=0.003],and the protective factors were chemotherapy after relapse [OR=0.379,95%CI=0.173-0.827,P=0.015],tumor cell ablation+ chemotherapy+/-radiotherapy after relapse [OR=0.126,95%CI= 0.016-1.000,P=0.050].Conclusions:1.Logistic regression analysis showed that the independent risk factors for postoperative recurrence included age,high grade of pathological differentiation,overexpression of P53,positive vascular tumor thrombus and negative ER.2.Multivariate COX regression analysis of prognosis after relapse showed that independent risk factors of prognosis after relapse included age.Compared with untreated patients after relapse,chemotherapy after relapse and tumor cell reduction plus chemotherapy or radiotherapy after relapse had better prognosis.In early endometrial cancer patients,patients with advanced age,high pathological grade,ER negative,P53 overexpression and vascular tumor thrombus are prone to relapse and metastasis after primary treatment.Postoperative adjuvant chemotherapy or systemic chemotherapy after relapse can improve the prognosis of patients.