Survival Rates and Prognostic Factors Among Patients with Endometrial Cancer

Abstract

Background: The assessment of patient survival outcomes in endometrial cancer (EC) is of paramount importance in evaluating the efficacy of its comprehensive management strategy. Objectives: This investigation aims at appraising overall survival (OS) and disease-free survival (DFS) in EC patients and elucidating prognostic factors that influence their long-term survival prospects. Methods: In this retrospective cohort study, medical records of patients with definitively diagnosed uterine EC referred to Shiraz Motahari Tumor Clinic from 2014 to 2018 were reviewed. Baseline demographic, pathological, clinical data, tumor characteristics, and outcome data were collected from the patients' medical records. Kaplan-Meier method and multivariate Cox regression were used to analyze factors and predictors of OS and PFS. Results: The estimated probabilities of 1, 3, and 5 years DFS were 93%, 90%, and 88%, respectively, and OS were 92%, 89%, and 89 % respectively. The mean age ± SD of patients was 57.67 ± 7.94 years, and 97.2% were married. The mean number of deliveries was 2.74 ± 1.63. Invasiveness features showed involvement of cervix stroma (12.8%), myometrium (lower than 50% was 70%, and more than 50% was 30%), lymphovascular invasion (LVI) (1.9%), adenex (5.30%), and lymph node (1.7%). Stage 1A, 1B, stage 2, stage 3A, stage 3C, and stage 4 were observed in 78.9%, 8.6%, 8.6%, 1.9%, 0.3%, and 1.7% of patients, respectively. Endometrioid carcinoma was the predominant type, accounting for 93.3% of cases (334), followed by papillary serous carcinoma (5.6%) (n = 20). Clear cell carcinoma was relatively uncommon (n = 4, 1.1%). At diagnosis, 29.5% of patients were grade 3, 21.5% were stage 3, and 12.0% were IV. The median minimum and maximum tumor sizes were 4.0 (> 0 - 12) cm. Cytopathology was positive in 1.1% of patients, and 68.6% of patients needed no second treatment, 5.8 % were treated using chemoradiation, 13.6% with brachytherapy, 0.8% with EBRT/brachytherapy, and 11.10% were treated with Brachytherapy/chemoradiation. Conclusions: International Federation of Gynecology and Obstetrics (FIGO) stages, tumor grade, marital status, lymph vascular invasion, deliveries, and age group of patients have been identified as predictors of survival. Early detection of EC enables optimal surgery.