Recurrent endometrial cancer: patterns of recurrent disease and assessment of prognosis

Aim

To evaluate patterns of disease and identify factors predicting outcome in patients presenting with recurrent endometrial adenocarcinoma following primary surgery.

Materials and methods

A retrospective review was performed of the imaging and clinical data in 86 patients (median age 66 years, range 42–88 years) presenting with recurrent endometrial adenocarcinoma following primary surgery.

Results

Following primary surgery recurrent disease occurred within 2 years in 64% and within 3 years in 87%. Relapse was seen within lymph nodes in 41 (46%), the vagina in 36 (42%) the peritoneum in 24 (28%) and the lung in 21 (24%). Unusual sites of disease included spleen, pancreas, rectum, muscle and brain. Univariate survival analysis showed the factors significant for poor outcome were: multiple sites of disease, liver and splenic disease, haematogenous, peritoneal and nodal spread, poorly differentiated tumour, and early relapse. The presence of disease within the vagina, bladder or lung was not associated with poor prognosis. Multivariate analysis identified multiple sites of disease, liver and splenic metastases to be independent predictors of poor outcome.

Conclusion

The most frequently observed sites of relapse are: lymph nodes, vagina, peritoneum and lung. Significant predictors of poor outcome in recurrent disease are multiple sites of disease and liver and splenic metastases.

Introduction

Endometrial cancer is the most common gynaecological malignancy in the UK with approximately 6000 new cases each year and 1500 deaths annually.¹ Most, 75–80%, of patients present with FIGO (International Federation of Gynaecology and Obstetrics) stage I disease and have a good prognosis with a 5 year survival of 80–90% and a locoregional recurrence rate of 4–8%.² Adjuvant pelvic radiotherapy has been associated with a decreased risk of local recurrence in patients with poor prognostic factors.3, 4, 5 However, at least 25–30% of these patients develop disease recurrence.6, 7, 8, 9, 10, 11, 12, 13 Recurrent disease is potentially salvageable with radiotherapy alone or in combination with surgery or chemotherapy.

Current methods of follow-up of patients treated for endometrial cancer usually consist of regular clinical evaluations. The use of imaging and its impact on the management of these patients is not well defined. There are limited data on the patterns of sites of relapse in endometrial cancer.14, 15 Previous studies have investigated predictors of relapse in endometrial adenocarcinoma6, 7 but once recurrence has occurred, the factors influencing outcome in this group of patients are not well described. Therefore the aim of the present study was not to identify features predicting relapse but to evaluate patterns of disease relapse, and to identify factors associated with poor outcome in patients presenting with recurrent endometrial adenocarcinoma.