The nature of early-stage endometrial cancer recurrence-A national cohort study.
The aim of the study was to present a comprehensive analysis of disease recurrence in a large Danish cohort of women with early-stage endometrial cancer treated according to national guidelines.



All women diagnosed with stage I or II endometrial cancer in 2005-2009 were included in a population-based historical cohort derived from the Danish Gynaecological Cancer Database. Disease recurrence up to 3 years after the primary diagnosis was identified using national registers and hospital charts. Follow-up on survival ended on 31st December 2014. We evaluated the predictive value of clinico-pathological and sociodemographic variables using multivariate logistic regression.



Recurrence within 3 years of the primary treatment was diagnosed in 183 (7%) of the included 2612 women. Site of recurrence significantly impacted on overall survival as the 5-year survival rate was 64.8% for women with vaginal recurrence and 17.5% in women with distant recurrence. Factors predictive of recurrence included the International Federation of Gynaecology and Obstetrics (FIGO) stage (OR: IB = 1.91, stage II = 3.91), Charlson comorbidity index of 3 (OR 1.86), non-endometrioid histology (OR 1.81) and being outside of the workforce (OR 1.81). Vaginal recurrence was predicted by FIGO stage only (OR: IB = 1.88, II = 2.79), while extra-vaginal recurrence was predicted by FIGO stage (OR: IB = 2.12, II = 3.31), Charlson comorbidity index of 3 (OR 1.88) and non-endometrioid histology (OR 2.51).



Future research should seek to understand the underlying mechanisms of the identified predictive factors to improve recurrence prediction and to reduce morbidity and mortality.
Department of Gynaecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Kloevervaenget 10, 5000 Odense C, Denmark. Electronic address: mmjepp1@gmail.com.
Mette Moustgaard
MM
Jeppesen
Department of Gynaecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Kloevervaenget 10, 5000 Odense C, Denmark.
Pernille Tine
PT
Jensen
The National Research Center of Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, JB Winsloewsvej 9A, 5000 Odense C, Denmark.
Dorte
D
Gilså Hansen
The Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Sdr Boulevard 29, 5000 Odense C, Denmark.
Maria
M
Iachina
Department of Obstetrics and Gynaecology, Karolinska University Hospital, SE-171 77 Stockholm, Sweden; Clinical Institute, University of Southern Denmark, Sdr Boulevard 29, 5000 Odense C, Denmark.
Ole
O
Mogensen
D018262:Adenocarcinoma, Clear Cell / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D018196:Carcinoma, Adenosquamous / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D018269:Carcinoma, Endometrioid / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D002296:Carcinosarcoma / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D016889:Endometrial Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D016015:Logistic Models; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D010052:Ovariectomy; D010388:Pelvis; D018714:Radiotherapy, Adjuvant; D012179:Retirement / Q000706:statistics & numerical data; D012307:Risk Factors; D058994:Salpingectomy; D018582:Sick Leave / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors; D014478:Unemployment / Q000706:statistics & numerical data; D014621:Vagina / Q000473:pathology
Disease recurrence; Endometrial carcinoma; Gynaecological malignancy; RSS; Relapse; Risk stratification