title: Defining prognostic variables in recurrent endometrioid endometrial cancer: a 15-year single-institution review.
abstract: OBJECTIVE
  This study aimed to examine the pattern of recurrence in patients with endometrioid endometrial cancer and to identify clinically important prognostic factors in the recurrent population.
  
  
  METHODS
  With institutional review board approval, a retrospective review identified 1061 patients who underwent primary surgery and treatment of endometrioid endometrial cancer at our institution from 1994 to 2007. Of this cohort, 77 (7.2%) patients developed a recurrence. Clinical factors were recorded, and Spearman correlation coefficients and χ test were used to determine associations between groups. Kaplan-Meier survival estimates and Cox proportional-hazards model were used to determine how prognostic variables affected survival after recurrence (RS) and overall survival (OS).
  
  
  RESULTS
  Of 77 patients, site of recurrence was not available in 5 patients. The distribution of recurrence in the remaining 72 patients was as follows: isolated vaginal 18% (13/72), nonvaginal pelvic 12% (9/72), distant 31% (22/72), abdominal 24% (17/72), and nodal 15% (11/72). There was an overrepresentation of advanced stage (P < 0.001) and high-grade (P < 0.003) at presentation in the recurrent group. Median OS was 3.4 years and median RS was 1.3 years. Low-grade tumors, early stage, and those with less than 50% myometrial invasion were associated with a significant OS and RS advantage. Age-adjusted isolated vaginal recurrence presented with a 1.2-year RS survival advantage (P < 0.03). An age-adjusted Cox proportional hazard ratio model incorporating significant prognostic variables demonstrated that the only independent variable associated with worse OS and RS was increased histologic grade with a hazard ratio of 2.31 (95% confidence interval, 1.25-3.97) for RS and 2.44 (95% confidence interval, 1.41-4.62) for OS.
  
  
  CONCLUSIONS
  Those patients with high-grade histology at the time of initial diagnosis manifest a decreased OS and RS, suggesting that the intrinsic biology of the tumor has the greatest prognostic importance.
authors.affiliation: Department of OB/GYN, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Katharine M
authors.initials: KM
authors.lastname: Esselen
authors.forename: David M
authors.initials: DM
authors.lastname: Boruta
authors.forename: Marcela
authors.initials: M
authors.lastname: del Carmen
authors.forename: John O
authors.initials: JO
authors.lastname: Schorge
authors.forename: Annekathryn
authors.initials: A
authors.lastname: Goodman
authors.forename: Whitfield B
authors.initials: WB
authors.lastname: Growdon
mesh_terms: D018269:Carcinoma, Endometrioid / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008404:Massachusetts; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies