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Abstract

This study aimed to define the disease free survival (DFS) and factors associated with recurrence in stage I endometrial cancer after surgery with and without adjuvant treatment. The demographic data, pathological results, adjuvant treatment (AT) and the outcome of patients with endometrial cancer stage I after surgery in Songklanagarind Hospital between January 2002 and July 2014 were collected. The DFS was analyzed by survival analysis and represented by Kaplan–Meier curves. The difference of DFS between AT and non-adjuvant treatment (NAT) groups was tested by the log-rank test. Distributions of risk factors by AT and recurrent status were analyzed using chi-square or Fisher exact tests for discrete factors, and unpaired t or Wilcoxon rank-sum tests for continuous factors. The 5-year DFS was; 91.6%, from a total of 268 patients. DFS in the NAT group was significantly better than that in the AT group (95.2 versus 86.5%, p-value = 0.01). Factors associated with recurrence in the NAT group were age, tumor grading, tumor size, and presence of lymphovascular involvement. Among the AT group, age and ratio of myometrial invasion were associated with recurrence. DFS in NAT was better than in AT and the potential factors associated with recurrence, after surgery with or without AT, were not the same.

Keywords

Survival endometrial cancer surgery

Article Details

How to Cite
Moradokkasem, W., Saeaib, N., & Liabsuetrakul, T. (2019). Disease Free Survival of Stage I Endometrial Cancer after Surgery with or without Adjuvant Treatment. Folia Medica Indonesiana, 55(1), 37–42. https://doi.org/10.20473/fmi.v55i1.24373

References

  1. Colombo N, Creutzberg C, Amant F, et al (2016). ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer 26, 2-30
  2. Creutzberg CL, van Putten WL, Koper PC, et al (2000). Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet 355, 1404-1411
  3. Creutzberg C L, van Putten WL, Warlam-Rodenhuis CC, et al (2004). Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the Postoperative Radiation Therapy in Endometrial Carcinoma Trial. J Clin Oncol 22, 1234-1241
  4. Demiral S, Beyzadeoglu M, Sager O, et al (2014). Evaluation of treatment outcomes of early-stage endometrial cancer radiotherapy: a single center experience. Asian Pac J Cancer Prev 15, 9599-9602
  5. dos Reis R, Burzawa JK, Tsunoda AT, et al (2015). Lymphovascular Space Invasion Portends Poor Prognosis in Low-Risk Endometrial Cancer. Int J Gynecol Cancer 25, 1292-1299
  6. Dunn EF, Geye H, Platta CS, et al (2014). Predictive factors of recurrence following adjuvant vaginal cuff brachytherapy alone for stage I endometrial cancer. Gynecol Oncol 133, 494-498
  7. Gadducci A, Cosio S, Landoni F, et al (2014). Adjuvant treatment and analysis of failures in patients with high-risk FIGO Stage Ib-II endometrial cancer: an Italian multicenter retrospective study (CTF study). Gynecol Oncol 134, 29-35
  8. Hacker NF, Friedlander ML (2015). Uterine Cancer. In Berek JS, Hacker NF (eds.), Berek & Hacker's Gynecologic Oncology (6th ed.), China, Wolters Kluwer, p 390-442
  9. Haltia UM, Butzow R, Leminen A, et al (2014). FIGO 1988 versus 2009 staging for endometrial carcinoma: a comparative study on prediction of survival and stage distribution according to histologic subtype. J Gynecol Oncol 25, 30-35
  10. Huijgens AN, Mertens HJ (2013). Factors predicting recurrent endometrial cancer. Facts Views Vis Obgyn 5, 179-186
  11. Imsamran W, Chaiwerawattana A, Wiangnon S, et al (2015). Cancer in Thailand Vol.VIII, 2010-2012. Bangkok: New Thammada Press.
  12. Jeppesen MM, Jensen PT, Hansen G, et al (2016). The nature of early-stage endometrial cancer recurrence-A national cohort study. Eur J Cancer 69, 51-60
  13. Keys HM, Roberts JA, Brunetto VL, et al (2004). A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 92, 744-751
  14. Kim J, Lee KJ, Park KR, et al (2016). Treatment outcomes after adjuvant radiotherapy following surgery for patients with stage I endometrial cancer. Radiat Oncol J 34, 265-272
  15. Koskas M, Huchon C, Amant F (2016). Characteristics and prognosis of patients with early-stage endometrial cancer who refuse adjuvant radiotherapy. Gynecol Oncol 141, 428-433
  16. Lajer H, Elnegaard S, Christensen RD, et al (2012). Survival after stage IA endometrial cancer; can follow-up be altered? A prospective nationwide Danish survey. Acta Obstet Gynecol Scand 91, 976-982
  17. NCCN.org (2018). Pennsylvania.: National Comprehensive Cancer Network. (2018). NCCN Clinical Practice Guideline in Oncology (NCCN Guidelines) : Uterine Neoplasms. [updated 2018 October 17]. Available from http://www.nccn.org/. Accessed November 6, 2018
  18. Rahatli S, Dizdar O, Kucukoztas N, et al (2014). Good outcomes of patients with stage IB endometrial cancer with surgery alone. Asian Pac J Cancer Prev 15, 3891-3893
  19. Therasakvichya S, Kuljarusnont S, Petsuksiri J, et al (2016). Clinical outcomes of stage I endometrial carcinoma patients treated with surgery alone: Siriraj Hospital experiences. J Gynecol Oncol 27, e48
  20. WCRF.org (2018). London: Wolrd Cancer Research Fund, & American Institute for Cancer Research. Endometrial cancer statistics. Available from https://www.wcrf.org/dietandcancer/cancer-trends/endometrial-cancer-statistics. Accessed November 6, 2018
  21. Zaki MA, Robbins JR, Fatteh S, et al (2012). Histological grade predicts for recurrence in patients with uterine endometrioid carcinoma without myometrial involvement. Anticancer Res 32, 4061-4065