title: Liver recurrence in endometrial cancer: a multi-institutional analysis of factors predictive of postrecurrence survival.
abstract: Predictive factors for survival following liver metastasis in endometrial cancer (EC) have not been studied to date. It is expected that patients who initially presented with liver metastasis or developed liver metastasis as the subsequent metastatic site of progressive disease are likely to have poor outcomes. However, patients developing liver metastasis as the first site of recurrence may have a chance of benefiting from the salvage therapies. Therefore, we aimed to determine factors influencing postrecurrence survival in EC patients who developed liver metastasis as the first site of recurrence. Patients with EC who underwent primary surgery at three centers between 1993 and 2013 were reviewed. Liver recurrence was defined as documentation of parenchymal liver metastasis either by radiologically or biopsy, after a disease-free interval of ≥3 months. Patients with liver metastasis at presentation, or liver metastasis as the subsequent metastatic site of progressive disease were excluded. Forty-six patients were identified. Median time to liver recurrence was 12 months, with 91.3 % of recurrences detected within 3 years. Most patients (73.9 %) had liver recurrence concomitant with extra-hepatic disease. Median survival after the diagnosis of liver recurrence was 9 months. While in univariate analysis, time to liver recurrence (p < 0.001) and presence of concomitant extra-hepatic metastasis (p = 0.048) were potential predictors of survival, multivariate analysis revealed that time to liver recurrence (p < 0.001) was the only independent predictor. This criterion may be used as a marker for stratifying patients into different prognostic risk groups and for selection of patients for salvage therapies.
authors.affiliation: Department of Gynecologic Oncological Surgery, Antalya Research and Training Hospital, D-Blok, Kat 2, 07070, Antalya, Turkey. drttoptas@gmail.com.
authors.forename: Tayfun
authors.identifier: 0000-0002-6706-6915
authors.initials: T
authors.lastname: Toptas
authors.affiliation: Department of Gynecologic Oncological Surgery, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Karalok
authors.affiliation: Department of Gynecologic Oncological Surgery, Antalya Research and Training Hospital, D-Blok, Kat 2, 07070, Antalya, Turkey.
authors.forename: Isin
authors.initials: I
authors.lastname: Ureyen
authors.affiliation: Department of Gynecologic Oncological Surgery, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Tasci
authors.affiliation: Department of Gynecologic Oncological Surgery, Antalya Research and Training Hospital, D-Blok, Kat 2, 07070, Antalya, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Erol
authors.affiliation: Department of Biostatistics and Medical Informatics, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Selen
authors.initials: S
authors.lastname: Bozkurt
authors.affiliation: Department of Gynecologic Oncological Surgery, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Tulunay
authors.affiliation: Department of Gynecologic Oncological Surgery, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Tayup
authors.initials: T
authors.lastname: Simsek
authors.affiliation: Department of Gynecologic Oncological Surgery, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Taner
authors.initials: T
authors.lastname: Turan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016896:Treatment Outcome
keywords: Endometrial cancer; Liver metastasis; Prognosis; Recurrence; Survival