RISK-FACTORS FOR RECURRENCE IN CLINICALLY EARLY ENDOMETRIAL CARCINOMA- AN ANALYSIS OF 183 CONSECUTIVE CASES

This study includes 183 patients with clinical stage I endometrial car cinoma. All patients had standard surgical staging procedure including peritoneal cytology, total abdominal hysterectomy, bilateral pelvic a nd paraaortic lymphadenectomy. The factors analysed for recurrence wer e age, menopausal state, cell type, grade, mitotic activity, myometria l invasion, lymphovascular space invasion, cervical involvement, micro scopic vaginal metastases, adnexal metastases, peritoneal cytology, co ncomitant endometrial hyperplasia and pelvic and paraaortic node metas tases. The overall recurrence rate was 14.2% (26/183). Of the 26 patie nts with recurrence, 11 had local and 13 had distant metastases. In th e remaining two patients (7.7%), both local and pelvic metastases were observed. Of the factors analysed, age, grade, mitotic activity, myom etrial invasion, lymphovascular space invasion, microscopic vaginal me tastases, adnexal involvement and pelvic and paraaortic nodal metastas es were found to be significant predictors of recurrence. After multiv ariate analysis, advanced age (RR = 1.05), marked mitotic activity (RR = 3.11), pelvic and/or paraaortic nodal metastases (RR = 6.37) were c hosen as the most important determinants of recurrence. In terms of su rgical pathological stages, recurrence risk reaches up to 45.4% for st age IIIC disease. Using surgical pathological parameters, it is possib le to predict recurrence but because of high rate of distant failures it still seems hard to improve survival of this group. Detection of a substantial risk of recurrence even in stage IA/B grade 1 group warran ts adjuvant therapy in all patients after primary surgery.