Int J Gynecol Cancer. 2018 May;28(4):684-691. doi: 10.1097/IGC.0000000000001223.
The identification of patients with endometrial cancer (EC) at higher risk for relapse is critical to individualize and better tailor postoperative treatment. No evidence is available regarding the possible association between tumor size (TS) and the risk of local recurrence. The purpose of this study was to analyze the correlation between TS and risk/type of recurrence in EC patients, stratified according to the new European Society of Medical Oncology-European Society of Gynecological Oncology-European Society for Radiotherapy and Oncology classification.
Data of patients with histologically proven EC who received primary surgical treatment between November 1999 and June 2015 were retrospectively retrieved from 5 institutions. Optimal TS cutoff was calculated using a receiver operating characteristic curve. Site of recurrence as a function of TS and groups of risk were analyzed. Local recurrence-free survival, recurrence-free survival, and overall survival were calculated using the Kaplan-Meier method.
Data of 1166 patients were analyzed. Among them, 514 (44.1%) had low-risk EC, 174 (14.9%) had intermediate risk EC, 173 (14.8%) had high-intermediate risk EC, and 305 (26.2%) had high-risk EC. A total of 134 (11.5%) women had recurrence: 47 (4%) of them had local relapse, 30 (2.6%) had locoregional relapse, and 57 (4.9%) had distant relapse. Tumor size 25 mm or greater emerged as the threshold for the prediction of a higher rate of local recurrence (P < 0.0001, hazard ratio = 18.2, P = 0.005) and a lower local recurrence-free survival and recurrence-free survival (P < 0.0001) only in patients with low-risk EC. There was no statistically significant correlation between TS and recurrence in the other risk groups.
In this very large series, tumor size emerges as an independent prognostic factor of local recurrence in women with low-risk EC and could be a valuable additional criterion to personalize the treatment approach to these patients.
识别子宫内膜癌（EC）患者的复发风险较高至关重要，有助于针对个体制定并更好地调整术后治疗方案。目前尚无证据表明肿瘤大小（TS）与局部复发风险之间存在关联。本研究的目的是分析根据新的欧洲肿瘤内科学会-欧洲妇科肿瘤学会-欧洲放射肿瘤学会分类，将 TS 与 EC 患者的复发风险/类型进行分层后的相关性。
回顾性检索了 5 家机构在 1999 年 11 月至 2015 年 6 月期间接受初次手术治疗的组织学证实为 EC 的患者的数据。使用受试者工作特征曲线计算最佳 TS 截止值。分析了 TS 与风险分组的复发部位之间的关系。采用 Kaplan-Meier 法计算局部无复发生存率、无复发生存率和总生存率。
共分析了 1166 例患者的数据。其中，514 例（44.1%）为低危 EC，174 例（14.9%）为中危 EC，173 例（14.8%）为高中危 EC，305 例（26.2%）为高危 EC。共有 134 例（11.5%）女性发生复发：47 例（4%）为局部复发，30 例（2.6%）为局部区域复发，57 例（4.9%）为远处转移复发。TS≥25mm 是预测局部复发率较高的阈值（P<0.0001，风险比=18.2，P=0.005），且与低危 EC 患者的局部无复发生存率和无复发生存率较低相关（P<0.0001）。在其他风险组中，TS 与复发之间无统计学显著相关性。
在本项大型系列研究中，肿瘤大小是低危 EC 患者局部复发的独立预后因素，可能是对这些患者进行个体化治疗的一个有价值的附加标准。
