Treatment failure in endometrial carcinoma.

OBJECTIVE: Our aim was to investigate the outcomes and prognostic factors after treatment failure of endometrial cancer.

METHODS: A total of 923 endometrial cancer patients were treated between 2000 and 2010, of which 109 experienced treatment failure. Treatment failure was defined as relapse after complete removal of all cancerous lesions or persistent/progressive disease despite treatment. Variables including clinicopathological features at initial treatment, type of primary treatment, failure pattern, salvage treatment, and outcomes were analyzed. Kaplan-Meier survival curves were compared with log-rank test. Cox proportional hazards regression model was used to identify significant prognostic factors.

RESULTS: Eighteen cases with persistent/progressive disease died shortly from primary diagnosis (1-23 months). The remaining 91 patients had recurrences in vagina only (8.8%), pelvis (3.3%), distant (63.7%), and combined pelvic-distant sites (24.2%). Median time to recurrence was 13.3 months (3.2-97.2 months). The median follow-up after recurrence of survivors was 60.5 months (10.6-121.7 months). The median survival after recurrence (SAR) was 20.3 months (1.9-121.7 months) with 5-year SAR rate of 32.4%. By multivariate analysis, initial stage II to IV (hazards ratio [HR], 3.41; 1.53-7.60; P = 0.003), type II histology (HR, 2.50; 1.28-4.90; P = 0.008), positive peritoneal cytology (HR, 2.23; 1.07-4.68; P = 0.033), and recurrence at multiple sites (HR, 2.51; 1.30-4.84; P = 0.006) were significantly associated with poor SAR. The 5-year SAR rates in patients with solitary vaginal, nodal/liver, or pulmonary/bony recurrence were 83.3%, 50.5%, and 24.2%, respectively. Ten cases with resectable or irradiatable recurrence at multiple sites or multiple relapses attained SAR greater than 5 years after multimodality salvage therapy.

CONCLUSIONS: Initial stage II to IV, type 2 histology, positive cytology, and recurrence at multiple sites were significant poor prognostic factors. Curative intent salvage therapy remains a viable option for cases with resectable or irradiatable multiple recurrences and solitary distant metastasis.