title: Prediction model for regional or distant recurrence in endometrial cancer based on classical pathological and immunological parameters.
abstract: BACKGROUND
  Adjuvant therapy increases disease-free survival in endometrial cancer (EC), but has no impact on overall survival and negatively influences the quality of life. We investigated the discriminatory power of classical and immunological predictors of recurrence in a cohort of EC patients and confirmed the findings in an independent validation cohort.
  
  
  METHODS
  We reanalysed the data from 355 EC patients and tested our findings in an independent validation cohort of 72 patients with EC. Predictors were selected and Harrell's C-index for concordance was used to determine discriminatory power for disease-free survival in the total group and stratified for histological subtype.
  
  
  RESULTS
  Predictors for recurrence were FIGO stage, lymphovascular space invasion and numbers of cytotoxic and memory T-cells. For high risk cancer, cytotoxic or memory T-cells predicted recurrence as well as a combination of FIGO stage and lymphovascular space invasion (C-index 0.67 and 0.71 vs 0.70). Recurrence was best predicted when FIGO stage, lymphovascular space invasion and numbers of cytotoxic cells were used in combination (C-index 0.82). Findings were confirmed in the validation cohort.
  
  
  CONCLUSIONS
  In high-risk EC, clinicopathological or immunological variables can predict regional or distant recurrence with equal accuracy, but the use of these variables in combination is more powerful.
authors.affiliation: Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Versluis
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: de Jong
authors.affiliation: Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Plat
authors.affiliation: Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Bosse
authors.affiliation: Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: V T
authors.initials: VT
authors.lastname: Smit
authors.affiliation: Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Mackay
authors.affiliation: Department of Clinical Oncology, Barts Health NHS trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Powell
authors.affiliation: Department of Medicine, Gynecology Unit, Gustave Roussy, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Leary
authors.affiliation: Division of Medical Oncology, Peter MacCallum Cancer Center, Victoria, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Mileshkin
authors.affiliation: Department of Gynecology, St Marys Hospital, Manchester, UK.
authors.forename: H C
authors.initials: HC
authors.lastname: Kitchener
authors.affiliation: Department of Gynecology, St Marys Hospital, Manchester, UK.
authors.forename: E J
authors.initials: EJ
authors.lastname: Crosbie
authors.affiliation: Department of Gynecology, St Marys Hospital, Manchester, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Edmondson
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: C L
authors.initials: CL
authors.lastname: Creutzberg
authors.affiliation: Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Hollema
authors.affiliation: Department of Medical Microbiology, Molecular Virology Section, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Daemen
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: G H
authors.initials: GH
authors.lastname: de Bock
authors.affiliation: Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: H W
authors.initials: HW
authors.lastname: Nijman
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000276:immunology / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology; D016896:Treatment Outcome