Abstract：
OBJECTIVE: To evaluate patterns of recurrence and explore the prognostic differences between the 2018 FIGO staging system and the 2020 ESGO-ESTRO-ESP risk stratification system of endometrial cancer with an emphasis on early-stage disease.
BACKGROUND: The incidence of endometrial cancer has risen by around 60% since the 90\'s. It is projected that by 2035 endometrial cancer will be the sixth most common cause of cancer-related death amongst females.
METHODS: This was a retrospective cohort study which included patients treated between 2010 and 2017. Primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Kaplan-Meyer survival analysis was used to assess OS and RFS across different risk groups. Cox proportional hazards regression was used to evaluate prognostic risk factors implicated in recurrence. Different recurrence patterns across the subgroups were analysed with Pearson\'s chi-square test.
RESULTS: The study included 692 patients with a recurrence rate of 14.9%. The median time to recurrence was 17.1 months (IQR:8.8-28.4). The mean OS varied between 97.2 months in the low-risk group to 63.1 months in the high-risk group (p < 0.001). Mean RFS was 96.1 in the low-risk group and 58.9 in the high-risk group (p < 0.001). RFS was predicted by the following factors; high risk group (OR=3.87; p = 0.041), LVSI (OR=2.54, p = 0.005), carcinosarcoma (OR=2.20, p = 0.021) and serous subtype (OR=1.91, p = 0.01). Logistic regression was used to evaluate risk factors for loco-regional and distant recurrence. Patients in the low-risk group were less likely to have distant recurrence (OR=0.08, p = 0.004). Similarly, negative LVSI and Grade 1 cancers were associated with decreased risk of distant recurrence (OR=0.34, p = 0.006 and OR=0.33, p = 0.007, respectively). There were no significant risk factors for loco-regional recurrence.
CONCLUSIONS: The 2020 ESGO-ESTRO-ESP risk stratification provides accurate estimates of recurrence risk and survival. Those treated in line with current guidance have significantly better outcomes.
BACKGROUND: The incidence of endometrial cancer has risen by around 60% since the 90\'s. It is projected that by 2035 endometrial cancer will be the sixth most common cause of cancer-related death amongst females.
METHODS: This was a retrospective cohort study which included patients treated between 2010 and 2017. Primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Kaplan-Meyer survival analysis was used to assess OS and RFS across different risk groups. Cox proportional hazards regression was used to evaluate prognostic risk factors implicated in recurrence. Different recurrence patterns across the subgroups were analysed with Pearson\'s chi-square test.
RESULTS: The study included 692 patients with a recurrence rate of 14.9%. The median time to recurrence was 17.1 months (IQR:8.8-28.4). The mean OS varied between 97.2 months in the low-risk group to 63.1 months in the high-risk group (p < 0.001). Mean RFS was 96.1 in the low-risk group and 58.9 in the high-risk group (p < 0.001). RFS was predicted by the following factors; high risk group (OR=3.87; p = 0.041), LVSI (OR=2.54, p = 0.005), carcinosarcoma (OR=2.20, p = 0.021) and serous subtype (OR=1.91, p = 0.01). Logistic regression was used to evaluate risk factors for loco-regional and distant recurrence. Patients in the low-risk group were less likely to have distant recurrence (OR=0.08, p = 0.004). Similarly, negative LVSI and Grade 1 cancers were associated with decreased risk of distant recurrence (OR=0.34, p = 0.006 and OR=0.33, p = 0.007, respectively). There were no significant risk factors for loco-regional recurrence.
CONCLUSIONS: The 2020 ESGO-ESTRO-ESP risk stratification provides accurate estimates of recurrence risk and survival. Those treated in line with current guidance have significantly better outcomes.
摘要：
目的：评估复发模式，并探讨2018年FIGO分期系统与2020年ESGO-ESTRO-ESP子宫内膜癌风险分层系统之间的预后差异，重点是早期疾病。
背景：自90年代以来，子宫内膜癌的发病率上升了约60%。预计到2035年，子宫内膜癌将成为女性癌症相关死亡的第六大常见原因。
方法：这是一项回顾性队列研究，包括2010年至2017年接受治疗的患者。主要终点是总生存期（OS）和无复发生存期（RFS）。Kaplan-Meyer生存分析用于评估不同风险组的OS和RFS。Cox比例风险回归用于评估与复发有关的预后危险因素。用Pearson卡方检验分析了不同亚组的不同复发模式。
结果：该研究包括692例患者，复发率为14.9%。中位复发时间为17.1个月(IQR:8.8-28.4)。低危组的平均OS在97.2个月至高危组的63.1个月之间变化（p<0.001）。低危组平均RFS为96.1，高危组平均RFS为58.9（p<0.001）。RFS由以下因素预测:高危人群(OR=3.87;p=0.041),LVSI（OR=2.54，p=0.005），癌肉瘤（OR=2.20，p=0.021）和浆液性亚型（OR=1.91，p=0.01）。采用Logistic回归分析评价局部区域和远处复发的危险因素。低危组患者远处复发的可能性较小（OR=0.08，p=0.004）。同样，LVSI阴性和1级癌症与远处复发风险降低相关(分别为OR=0.34,p=0.006和OR=0.33,p=0.007).局部区域复发没有明显的危险因素。
结论：2020年ESGO-ESTRO-ESP风险分层提供了对复发风险和生存率的准确估计。那些按照当前指导进行治疗的患者具有明显更好的结果。
背景：自90年代以来，子宫内膜癌的发病率上升了约60%。预计到2035年，子宫内膜癌将成为女性癌症相关死亡的第六大常见原因。
方法：这是一项回顾性队列研究，包括2010年至2017年接受治疗的患者。主要终点是总生存期（OS）和无复发生存期（RFS）。Kaplan-Meyer生存分析用于评估不同风险组的OS和RFS。Cox比例风险回归用于评估与复发有关的预后危险因素。用Pearson卡方检验分析了不同亚组的不同复发模式。
结果：该研究包括692例患者，复发率为14.9%。中位复发时间为17.1个月(IQR:8.8-28.4)。低危组的平均OS在97.2个月至高危组的63.1个月之间变化（p<0.001）。低危组平均RFS为96.1，高危组平均RFS为58.9（p<0.001）。RFS由以下因素预测:高危人群(OR=3.87;p=0.041),LVSI（OR=2.54，p=0.005），癌肉瘤（OR=2.20，p=0.021）和浆液性亚型（OR=1.91，p=0.01）。采用Logistic回归分析评价局部区域和远处复发的危险因素。低危组患者远处复发的可能性较小（OR=0.08，p=0.004）。同样，LVSI阴性和1级癌症与远处复发风险降低相关(分别为OR=0.34,p=0.006和OR=0.33,p=0.007).局部区域复发没有明显的危险因素。
结论：2020年ESGO-ESTRO-ESP风险分层提供了对复发风险和生存率的准确估计。那些按照当前指导进行治疗的患者具有明显更好的结果。
