| Objective:To analyze risk factors of recurrence prognosis in patients which were divided into intermediate risk group and high-intermediate risk group in endometrial carcinoma,and the effects of different adjuvant therapies on the prognosis of patients.Method:A total of 364 cases were collected from June 1,2013 to December 31,2020 in Qilu Hospital of Shandong University who underwent surgery for endometrial cancer.The clinical data of patients were recorded using database information and case inquiry system,and were conducted retrospective analysis by SPSS 26.0.The ROC curve was used to determine the predictive significance of relevant indicators for DFS and OS,and to determine the optimal critical value.P<0.05 was statistically significant.Then tested the two groups by the Log-Rank method,and drew the survival curve of the statistically significant factors using the Kaplan-Meier method.The significative factors were included in the Cox proportional model for multivariate analysis.Factor analysis was performed to select independent risk factors affecting survival and prognosis in different groups.Results:1.In the analysis of the prognosis of adjuvant therapy,postoperative adjuvant therapy had a statistically significative effect in the overall survival of the intermediate risk group and the high-intermediate risk group(P<0.001 in the intermediate risk group and P=0.01 in the high-intermediate risk group).Disease-free survival did not differ statistically significantly.Subgroup analyses revealed that adjuvant chemotherapy and chemotherapy-radiotherapy had no statistically significant impact on overall survival.2.In the intermediate risk group,univariate analysis showed that NLR ratio,LMR ratio,PR,and pathological type were related to disease recurrence,and NLR ratio,pelvic lymph node resection status and postoperative adjuvant therapy were related to overall survival;multivariate analysis showed that LMR ratio(OR=11.066,95%CI=1.386-88.339,P=0.023),pathological type(OR=14.758,95%CI=3.885-56.057,P<0.001)were the factors associated with recurrence in the intermediate risk group,pelvic lymph node resection status(OR=3.420,95%CI=1.090-10.728,P=0.035)and adjuvant treatment postoperatively(OR=4.207,95%CI=1.557-10.415,P=0.004)were the independent risk factors for the overall survival in the intermediate risk group.3.In the high-intermediate risk group,LMR ratio,invasion of the myometrium,ER,histological grade and Ki67 positive rate had a certain correlation with disease recurrence,age of onset,menopausal status,diabetes mellitus,surgical route,histological grade,and invasion of the myometrium were related to overall survival;The positive rate of Ki67(OR=9.953,95%CI=2.413-41.055,P=0.001)and the ER value(OR=6.484,95%CI=1.442-29.144,P=0.015)were the independent risk factors for the disease recurrence in the high-intermediate risk group.Conclusion:In endometrial cancer,adjuvant therapy improved overall survival,but had no effect on disease-free survival.Differences were not significant in prognosis between adjuvant chemoradiotherapy and adjuvant chemotherapy.In the intermediate risk group,the non-endometrioid carcinoma pathological type and the LMR ratio<5.193 indicated that the patients had an increased risk of recurrence.The survival time of patients was significantly correlated with pelvic lymph node dissection and whether postoperative adjuvant therapy was performed.In the high-intermediate risk group,the positive rate of Ki67 higher than 65%and the negative status of ER indicated a high risk of disease recurrence. |
