To identify patients with endometrial cancer at risk for hematogenous,lymphatic,or perito neal recurrence(or combinations of them)who might potentially benefit from target -based therapies.During a 13-year period,915patients had endometrial cancer man aged with hysterectomy and standard adjuvant therapy.On th e basis of our previous regression analyses,depth of myome trial invasion predicted the risk for hematogenous recurrence;positive lymph nodes and cervical stromal invasion predi cted lymphatic recur-rence;stage IV disease or combination of nonendometrioid histology,cervical stromal invasion,positive lymph nodes,and positive peritoneal cytology wa s predictive of peritoneal recurrence.Median follow -up was 66months.Applying the above criteria to the population of 915patients,24%were considered at risk for hematogenous recur -rence,18%for lymphatic recurrence,and 16%for peritoneal recurrence.The respective relapse rates at 5years were28%for patients who were at risk for h ematogenous re-currence,31%for lymphatic recurre nce,and 42%for peritoneal recurrence.This contra sted with less than a 5%recurrence rate in the correspondin g subgroups not at risk for relapse(P <0.001).Collectively,of the 915pa-tients,324(35%)were considered at risk for recurren ce in one or more of the above three sites.Overall,89%of all recurrences were identified in this at -risk group.Impor-tantly,46%of the patients considered at risk subsequently had recurrence in one or more of the th ree sites,compared with only 2%of patients not at risk fo r relapse(P<0.001).Patients at risk for relapse had a 46%probability of experiencing recurrence within 5years despite manage-ment with standard therapy.New targ et -based algorithms for the 35%of endometrial cancer patients deemed at risk should be incorporated in the develo pment of future prospective multimodality clinica l trials predicated on site(s)of recurrence.
展开▼
