Risk Factors and Prognosis of Early Recurrence in Stage I-II Endometrial Cancer: A Large-Scale, Multi-Center, and Retrospective Study

Yingyu Dou; Kun Song; Yu Fu; Yuanming Shen; Chuyao Zhang; Shuzhong Yao; Congjian Xu; Min Xia; Ge Lou; Jihong Liu; Bei Lin; Jianliu Wang; Weidong Zhao; Jieqing Zhang; Wenjun Cheng; Hongyan Guo; Ruixia Guo; Fengxia Xue; Xipeng Wang; Lili Han; Xia Zhao; Xiaomao Li; Ping Zhang; Jianguo Zhao; Jiezhi Ma; Wenting Li; Xiaohang Yang; Zizhuo Wang; Jingbo Liu; Yong Fang; Kezhen Li; Gang Chen; Chaoyang Sun; Xiaodong Cheng; Jie Jiang; Beibei Wang; Danfeng Luo; Beihua Kong; Chinese Endometrial Carcinoma Consortium (CECC)

doi:10.3389/fmed.2022.808037

Risk Factors and Prognosis of Early Recurrence in Stage I-II Endometrial Cancer: A Large-Scale, Multi-Center, and Retrospective Study

Front Med (Lausanne). 2022 Apr 14:9:808037. doi: 10.3389/fmed.2022.808037. eCollection 2022.

Authors

Yingyu Dou^{1

2}, Kun Song³, Yu Fu^{1

2}, Yuanming Shen⁴, Chuyao Zhang⁵, Shuzhong Yao⁶, Congjian Xu⁷, Min Xia⁸, Ge Lou⁹, Jihong Liu⁵, Bei Lin¹⁰, Jianliu Wang¹¹, Weidong Zhao¹², Jieqing Zhang¹³, Wenjun Cheng¹⁴, Hongyan Guo¹⁵, Ruixia Guo¹⁶, Fengxia Xue¹⁷, Xipeng Wang¹⁸, Lili Han¹⁹, Xia Zhao²⁰, Xiaomao Li²¹, Ping Zhang²², Jianguo Zhao^{23

24}, Jiezhi Ma²⁵, Wenting Li^{1

2}, Xiaohang Yang^{1

2}, Zizhuo Wang^{1

2}, Jingbo Liu^{1

2}, Yong Fang^{1

2}, Kezhen Li^{1

2}, Gang Chen^{1

2}, Chaoyang Sun^{1

2}, Xiaodong Cheng⁴, Jie Jiang³, Beibei Wang^{1

2}, Danfeng Luo^{1

2}, Beihua Kong³; Chinese Endometrial Carcinoma Consortium (CECC)

Affiliations

¹ Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
² Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
⁴ Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁵ Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
⁶ Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁷ Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
⁸ Department of Gynecology and Obstetrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
⁹ Department of Gynecology Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
¹⁰ Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, China.
¹¹ Department of Gynecology, Peking University People's Hospital, Beijing, China.
¹² Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Baohe District, China.
¹³ Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, China.
¹⁴ Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
¹⁵ The Third Hospital of Peking University, Beijing, China.
¹⁶ Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
¹⁷ Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China.
¹⁸ Department of Gynecology and Obstetrics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹⁹ Department of Gynecology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
²⁰ Department of Gynecology and Obstetrics, Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China.
²¹ Department of Gynecology and Obstetrics, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
²² Department of Gynecology, The Second Hospital of Shandong University, Jinan, China.
²³ Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Affiliated Hospital of Nankai University, Tianjin, China.
²⁴ Department of Gynecologic Oncology, Tianjin Clinical Research Center for Gynecology and Obstetrics, Branch National Clinical Research Center for Gynecology and Obstetrics, Tianjin, China.
²⁵ Department of Obstetrics and Gynecology, Xiangya Third Hospital, Central South University, Changsha, China.

Abstract

Objective: The aim of the present study was to determine overall survival (OS) and risk factors associated with early recurrence in patients with FIGO I-II stage endometrial carcinoma (EC).

Methods: Clinical features were retrospectively extracted from the database of China Endometrial Cancer Consortium from January 2000 to December 2019. A total of 2,974 patients with Federation International of Gynecology and Obstetrics (FIGO) I-II stage endometrial cancer were included. Kaplan-Meier survival analysis was used to assess OS and disease-specific survival. Cox proportional hazard model and Fine-Gray model were used to determine the factors related to OS. Binary logistic regression model was used to determine independent predictors of early relapse patients.

Results: Of these 2,974 ECs, 189 patients were confirmed to have relapse. The 5-year OS was significantly different between the recurrence and non-recurrence patients (p < 0.001). Three quarters of the relapse patients were reported in 36 months. The 5-year OS for early recurrence patients was shorter than late recurrence [relapse beyond 36 months, p < 0.001]. The grade 3 [odds ratio (OR) = 1.55, 95%CI 1.17-2.05, p = 0.002], lymphatic vascular infiltration (LVSI; OR = 3.36; 95%CI 1.50-7.54, p = 0.003), and myometrial infiltration (OR = 2.07, 95%CI 1.17-3.65, p = 0.012) were independent risk factors of early relapse. The protective factor of that is progesterone receptor (PR)-positive (OR = 0.50, 95%CI 0.27-0.92, p = 0.02). Bilateral ovariectomy could reduce recurrence risk rate (OR = 0.26, 95%CI 0.14-0.51, p < 0.001).

Conclusion: The OS of early relapse EC is worse. Grade 3, LVSI, and myometrial infiltration are independent risk factors for early relapse EC. In addition, the protective factor is PR-positive for those people and bilateral salpingo-oophorectomy could reduce the risk of recurrence.

Keywords: clinical features; early recurrence; endometrial cancer; recurrence pattern; risk factors.

Copyright © 2022 Dou, Song, Fu, Shen, Zhang, Yao, Xu, Xia, Lou, Liu, Lin, Wang, Zhao, Zhang, Cheng, Guo, Guo, Xue, Wang, Han, Zhao, Li, Zhang, Zhao, Ma, Li, Yang, Wang, Liu, Fang, Li, Chen, Sun, Cheng, Jiang, Wang, Luo, Kong and the Chinese Endometrial Carcinoma Consortium (CECC).