title: Patterns of failures in endometrial cancer: clinicopathological variables predictive of the risk of local, distant and retroperitoneal failure.
abstract: The aim of this study was to assess the pattern of failure and the outcome of endometrial cancer patients and to analyze the variables predictive of the risk of local, distant and retroperitoneal lymph node disease recurrence.
  
  
  METHODS
  The authors assessed 511 patients who underwent primary surgery. The median follow-up of survivors was 74 months. Peritoneal, hematogenous and lymph node recurrences outside retroperitoneal area were considered as distant failures.
  
  
  RESULTS
  Tumor relapsed in 83 (16.2%) patients. Median time to recurrence was 18.5 months (range, 3-129 months). The relapse was local in 13 cases, distant in 37, retroperitoneal in 22, and involved both distant and other sites in 11. Logistic regression showed that cervical involvement was the only independent predictor of local recurrence. Tumor grade, lymph-vascular space involvement (LVSI) and myometrial invasion were independent predictors of distant failure. Lymph node status and tumor grade were independent predictors of retroperitoneal recurrence. Five- and 10-year overall survival rates were 87.1% and 79.5%, respectively. Patient age, lymph node status, cervical involvement, tumor grade, LVSI and myometrial invasion were independent prognostic variables for overall survival.
  
  
  CONCLUSIONS
  Cervical involvement was an independent predictor of local recurrence, LVSI and myometrial invasion were independent predictors of distant failure, lymph node status was an independent predictor of retroperitoneal relapse, and tumor grade was an independent predictor of both distant and retroperitoneal recurrence. The identification of risk factors for different patterns of failure can be useful in better tailoring adjuvant treatment.
authors.affiliation: Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Via Roma 56, Pisa 56127, Italy. a.gadducci@obgyn.med.unipi.it
authors.forename: Angiolo
authors.initials: A
authors.lastname: Gadducci
authors.forename: Stefania
authors.initials: S
authors.lastname: Cosio
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Fabrini
authors.forename: Antonio
authors.initials: A
authors.lastname: Fanucchi
authors.forename: Cecilia
authors.initials: C
authors.lastname: Barsotti
authors.forename: Renza
authors.initials: R
authors.lastname: Cristofani
authors.forename: Carlo
authors.initials: C
authors.lastname: Greco
authors.forename: Andrea Riccardo
authors.initials: AR
authors.lastname: Genazzani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012186:Retroperitoneal Neoplasms / Q000556:secondary*; D012307:Risk Factors; D017211:Treatment Failure