Time to Recurrence after Primary Treatment Predicts Survival of Patients with Stage I-Ii Endometrial Cancer

To determine the effect of time to recurrence on overall survival (OS) and disease specific survival (DSS) in patients with stage I- II uterine endometrioid carcinoma. In this IRB approved retrospective study, we reviewed 1251 patients with uterine cancer in our UCARE (Uterine Cancer Research Endeavor) database. We identified 57 patients with recurrent endometrioid carcinoma who underwent surgical staging with and without adjuvant radiation treatment (RT) for FIGO stages I-II between 1987 and 2008. Patients with non-endometrioid carcinoma, mixed histologies and those who received preoperative radiation treatment or systemic therapy were excluded from this analysis. The OS and disease DSS were estimated using a Kaplan-Meier approach from the date of recurrence. Cox regression was used to explore the risks of various factors on recurrence. Median age for the study cohort was 65 years (range 33 - 90). Adjuvant radiation was given to 29 patients (51%) with either external beam radiation, vaginal cuff brachytherapy, or both. There were 29 patients with locoregional (vaginal and/or pelvic) recurrences (51%) and 28 patients with extra pelvic recurrences (49%). Median time to recurrence was 16 months (range 1 - 165 months). There were 26 (46%) patients that had a recurrence ≤12 months and 31 (54%) who had a recurrence >12 months. All patients but one had salvage treatment of their recurrence. Median OS and DSS were 19 months and 25 months respectively. On multivariate analysis, the following factors were statistically significant independent predictors of shorter OS: recurrence time less than 12 months (p<0.001) and locoregional recurrence (p = 0.011). The same factors were statistically significant independent predictors of shorter DSS with p = <0.001 and p = 0.003, respectively. The median OS in patients with a recurrence in ≤12 months was 7 months versus 69 months in patients with a recurrence in >12 months. The median DSS in patients with a recurrence in ≤12 months was 7 months versus 81 months in patients with a recurrence in >12 months. The 5 year OS rate in patients with a recurrence ≤12 months was 5.6% compared to 54.2% in patients with a recurrence >12 months. The 5 year DSS rate in patients with a recurrence ≤12 months was 12.5% compared to 60% in patients with a recurrence >12 months. There was no significant difference in OS or DSS between patients that received adjuvant radiation and those that did not. Early recurrence was significantly associated with a decreased overall and disease specific survival in patients with stage I-II endometrioid carcinoma despite salvage therapy. The use of adjuvant radiation was not significantly associated with decreased survival after recurrence.