[1227] Risk Factors for Recurrence in Sites Other Than Vagina in Patients with Low Grade Endometrial Adenocarcinoma. A Multi-Institutional Study

Andres A Roma, Denise A Barbuto, Elizabeth Euscher, Rouba Ali-Fehmi, Bojana Djordjevic, Jennifer A Bennett, Elizabeth Frauenhoffer, Sun Rang Hong, Insun Kim, Delia Montiel, Elizabeth Moschiano, Anais Malpica, Elvio Silva. Cleveland Clinic, Cleveland, OH; Cedar Sinai, Los Angeles, CA

Background: There is no significant data analyzing risk factors in low grade endometrial tumors that would predict site of recurrence.
Design: We compiled data from 1991-2011 for patients with FIGO grade 1 and 2 endometrial adenocarcinomas, including 79 patients with extrauterine recurrence (follow-up 44 months), 38 patients with vaginal recurrence alone (follow-up 57 months), and 187 age matched control patients that had negative lymph nodes (LN), no adjuvant treatment, and did not recur (follow-up 59 months). We further stratified the recurrence group (those with metastatic LN, negative LN and those without resected LN; pelvic/abdominal recurrence (excluding vaginal) and those with recurrence at distant sites.
Results: Overall, 56 recurrent cases (71%) had lymphovascular invasion (LVI) and 41 (73%) of these recurred at distant sites. Of 187 controls, only 26% had LVI (p<0.0001), similar to 21% LVI in vaginal recurrence cases (p<0.0001). Recurrent cases with LN metastasis at the time of hysterectomy showed LVI in 96% and 78% recurred at distant sites. While 45% of cases with negative LN lacked LVI and 64% of these recurred in the pelvic/abdominal region. Additional data is summarized in Table 1. Tumor size, myoinvasion depth, cervical involvement and cervical stromal involvement were statistically different between recurrences (excluding vaginal) and controls (p<0.0001) while the presence of microcystic, elongated and/or fragmented (MELF) pattern of invasion was statistically different (p<0.03).

 SizeMyoinvasionMELFCervical stroma
Distant (54)4.951.6% (26>50%; 8>33%)20.2%17
Pelvic (25)5.341.4% (10>50%; 3>33%)17.8%5
Controls (187)3.326.9% (41>50%;22>33%)10.2%11
MELF: average MELF % at invasive front of tumor; Myoinvasion depth: average (cases >50%; cases 33-50%)


Conclusions: 1. LVI is a significant risk factor for recurrences in low grade endometrial adenocarcinoma, but not significant for vaginal recurrence.
2. Risk factors other than LVI do not appear to be useful in predicting the site of recurrence, pelvic/abdominal or distant.
3. Recurrences at LN or distant sites were significantly associated with LVI, indicating lymphvascular dissemination.
4. However, pelvic/abdominal recurrences were not associated with LVI, especially in cases with negative LN, suggesting a different dissemination route other than lymphvascular, possibly transtubal.
5. Low grade tumors that are smaller, show less myoinvasion (less than 33%), and no cervical involvement are significantly less commonly associated with recurrence.
Category: Gynecologic & Obstetrics

Monday, March 4, 2013 11:30 AM

Proffered Papers: Section E, Monday Morning

 

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