title: Endometrioid uterine cancer: histopathological risk factors of local and distant recurrence.
abstract: OBJECTIVE
  To determine the relationship between histopathological prognostic factors and sites of initial recurrence in endometrioid uterine cancer.
  
  
  METHODS
  A total of 355 patients (Stage I, n=227; II, n=38; III, n=90) underwent primary radical surgery including complete systematic pelvic lymph node (PLN) and para-aortic lymph node (PALN) adenectomy followed by adjuvant chemotherapy who were at risk for recurrence. Relapse-free survival (RFS) and disease-related survival (DRS) were analyzed using the log-rank testing. Multivariate Cox regression analysis and logistic regression analysis were used to determine and estimate independent prognostic factors.
  
  
  RESULTS
  Lymph-vascular space invasion (LVSI), architectural grade (AG), myometrial invasion, and PLN metastasis (PLNM) were identified as independent prognostic factors for RFS. AG (p=0.0043) related with local recurrence. Among patients who received adjuvant chemotherapy, patients with G3 tumor had higher ratio of recurrence (16/45) compared with G1/2 tumor (11/102) (p=0.0004). Meanwhile, PLNM related with distant recurrence (p=0.0008). There was a statistically significant difference in RFS according to the number of positive PLN sites (group 0: n=313, 1: n=16, > or =2: n=26), five-year RFS in each group was 91.9%, 81.3%, and 41.2%, respectively.
  
  
  CONCLUSIONS
  Sites of initial recurrence were related with AG and PLNM in patients with endometrioid uterine cancer. Current chemotherapy alone may not be an effective adjuvant therapy to prevent recurrence in patients with G3 tumor and > or =2 positive PLN sites. Prospective clinical trial needs to be conducted to establish the strategy of adjuvant therapy with these patients.
authors.affiliation: Department of Obstetrics and Gynecology, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan. fujimotot@obgyn.med.akita-u.ac.jp
authors.forename: Toshio
authors.initials: T
authors.lastname: Fujimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nanjyo
authors.forename: Jun
authors.initials: J
authors.lastname: Fukuda
authors.forename: Akira
authors.initials: A
authors.lastname: Nakamura
authors.forename: Hideki
authors.initials: H
authors.lastname: Mizunuma
authors.forename: Nobuo
authors.initials: N
authors.lastname: Yaegashi
authors.forename: Toru
authors.initials: T
authors.lastname: Sugiyama
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Kurachi
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.forename: Toshinobu
authors.initials: T
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018269:Carcinoma, Endometrioid / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery