title: Predictive factors for prolonged survival in recurrent endometrial carcinoma: Implications for follow-up protocol.
abstract: OBJECTIVE
  To evaluate the role of follow-up after curative treatment in endometrial carcinoma, we determined predictive factors for prolonged survival after recurrence.
  
  
  METHODS
  We retrospectively studied patients with endometrioid endometrial carcinoma who had a follow-up appointment consisting of pelvic examination, vaginal cytology, imaging and CA-125 measurements and who developed recurrence. Possible prognostic factors were evaluated by univariate and multivariate analyses.
  
  
  RESULTS
  Fifty-one patients developed recurrence. The median time from initial treatment to recurrence was 12 months (range, 3-119 months). A total of 25 (49%) and 45 (88%) recurrences were detected within 1 and 3 years of initial treatment, respectively. Twenty (39%) patients were symptomatic, while 31 (61%) were asymptomatic. The median survival time of symptomatic patients was longer than that of asymptomatic patients (27 vs. 12 months); however, the difference was not statistically significant (P = 0.42). No recurrences were detected by vaginal cytology. Of asymptomatic patients with low/intermediate risk (stage I/II), patients with recurrence detected by imaging or CA-125 measurements tended to have shorter survival than patients with recurrence detected by physical examination (7 vs. 31+ months, P = 0.057). Multivariate analysis revealed that site of recurrence (vaginal vs. extravaginal, P < 0.01) and time to recurrence (> 1 year vs. ≤ 1 year, P = 0.01) were significant independent predictors of prolonged survival after recurrence.
  
  
  CONCLUSIONS
  In endometrial carcinoma, site of and time to recurrence are significant predictive factors of prolonged survival after recurrence, suggesting that early detection of recurrence by imaging studies and CA-125 measurements cannot improve prognosis. Although intensive follow-up using these methods may provide psychological reassurance to some patients, the use of these methods must be balanced against the wise use of limited health care resources.
authors.affiliation: Department of Gynecology, Kameda Medical Center, Kamogawa, Chiba, Japan. i.otsuka@kameda.jp
authors.forename: Isao
authors.initials: I
authors.lastname: Otsuka
authors.forename: Masaya
authors.initials: M
authors.lastname: Uno
authors.forename: Akira
authors.initials: A
authors.lastname: Wakabayashi
authors.forename: Shogo
authors.initials: S
authors.lastname: Kameda
authors.forename: Hideo
authors.initials: H
authors.lastname: Udagawa
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kubota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood; D018269:Carcinoma, Endometrioid / Q000097:blood / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology* / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D018394:CA-125 Antigen