title: Recurrence patterns and survival endpoints in women with stage II uterine endometrioid carcinoma: a multi-institution study.
abstract: OBJECTIVE
  There is paucity of data in regard to prognostic factors and outcome of women with 2009 FIGO stage II disease. The objective of this study was to investigate prognostic factors, recurrence patterns and survival endpoints in this group of patients.
  
  
  METHODS
  Data from four academic institutions were analyzed. 130 women were identified with 2009 FIGO stage II. All patients underwent hysterectomy, oophorectomy and lymph node evaluation with or without pelvic and paraaortic lymph node dissections and peritoneal cytology. The Kaplan-Meier approach and Cox regression analysis were used to estimate recurrence-free (RFS), disease-specific (DSS) and overall survival (OS).
  
  
  RESULTS
  Median follow-up was 44months. 120 patients (92%) underwent simple hysterectomy, 78% had lymph node dissection and 95% had peritoneal cytology examination. 99 patients (76%) received adjuvant radiation treatment (RT). 5-year RFS, DSS and OS were 77%, 90%, and 72%, respectively. On multivariate analysis of RFS, adjuvant RT, the presence of lymphovascular space invasion (LVSI) and high tumor grades were significant predictors. For DSS, LVSI and high tumor grades were significant predictors while older age and high tumor grade were the only predictors of OS.
  
  
  CONCLUSIONS
  In this multi-institutional study, disease-specific survival for women with FIGO stage II uterine endometrioid carcinoma is excellent. High tumor grade, lymphovascular space invasion, adjuvant radiation treatment and old age are important prognostic factors. There was no significant difference in the outcome between patients who received vaginal cuff brachytherapy compared to those who received pelvic external beam radiation treatment.
authors.affiliation: Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA. Electronic address: melshai1@hfhs.org.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elshaikh
authors.affiliation: Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Al-Wahab
authors.affiliation: Gynecologic Oncology Division, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Haider
authors.initials: H
authors.lastname: Mahdi
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Albuquerque
authors.affiliation: Department of Public Health Science, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Mahan
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Siobhan M
authors.initials: SM
authors.lastname: Kehoe
authors.affiliation: Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Rouba
authors.initials: R
authors.lastname: Ali-Fehmi
authors.affiliation: Gynecologic Oncology Division, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.affiliation: Division of Gynecologic Oncology, Department of Women's Health Services, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Adnan R
authors.initials: AR
authors.lastname: Munkarah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis
keywords: Brachytherapy; Endometrial carcinoma; Hysterectomy; Prognosis; Recurrence; Stage II