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).
|Distant (54)||4.9||51.6% (26>50%; 8>33%)||20.2%||17|
|Pelvic (25)||5.3||41.4% (10>50%; 3>33%)||17.8%||5|
|Controls (187)||3.3||26.9% (41>50%;22>33%)||10.2%||11|