Quantifying the risk of recurrence and death in stage III (FIGO 2009) endometrial cancer

• Stage III endometrial cancer patients are heterogeneous and have varied prognoses.
• High-grade histology, positive cytology, & myometrial invasion predict poor outcome.
• These risk factors are more prognostically discriminating than FIGO subgroup.

ObjectiveAdvanced endometrial cancer patients comprise a heterogeneous group. This study assessed the association of clinicopathological factors with relapse and death from endometrial cancer.MethodsEligible patients were treated for stage III (FIGO 2009) endometrial adenocarcinoma, had peritoneal cytology performed, and had no gross residual disease post-operatively.ResultsOf 192 patients, 59% were ≥ 60 years old, 48% had ≥ 50% myometrial invasion, 71% lymphovascular invasion, 25% cervical stromal invasion, 37% adnexal involvement, and 23% positive peritoneal cytology. High-grade histology (serous, clear cell, undifferentiated, or grade 3 endometrioid) was present in 45%. Pelvic lymphadenectomy was performed in 93% and para-aortic lymphadenectomy in 73%. Adjuvant chemotherapy and/or radiation therapy was administered to 93%. At a median follow-up of 42 months, the 5-year rate of relapse was 37% and of death from endometrial cancer was 30%. On multivariate analysis, both outcomes were associated with high-grade histology, positive peritoneal cytology, and deep myometrial invasion (p ≤ 0.04). The cohort was divided into subgroups of patients with 0 (n = 46), 1 (n = 83), or ≥ 2 (n = 63) of these high-risk characteristics. The 5-year relapse rate for patients with 0 risk factors was 13%, 1 risk factor was 27%, and ≥ 2 risk factors was 62% (p < 0.001). The corresponding 5-year rates of death from endometrial cancer were 11%, 20%, and 56%, respectively (p < 0.001).ConclusionsStratification of stage III endometrial cancer according to high-grade histology, positive peritoneal cytology, and deep myometrial invasion is useful for prognostication and may grant insight into the optimal treatment for specific subgroups of patients.