Objectives: The aim of this study was to evaluate the survival estimates, treatment outcomes, prognostic factors, and recurrence patterns of patients with surgical stage II endometrial cancer.
Methods: Forty-eight stage II endometrial cancer patients treated between 1982 and 2000 were included. All the patients were subjected to the initial surgical staging procedure consisting of peritoneal cytology, infracolic omentectomy, abdominal hysterectomy (radical or simple), bilateral salpingo-oophorectomy, and complete pelvic-paraaortic lymphadenectomy. Of these 48 patients, 21 (44%) were treated with radical hysterectomy (RH) without adjuvant therapy. The remaining 27 (56%) patients were treated with simple hysterectomy plus adjuvant radiotherapy. With respect to the prognostic factors, no statistically significant difference was found between these two groups. The median follow-up period was 5 years (range, 2-9).
Results: The mean age at the time of diagnosis was 55.8 years (range, 34-75). The 5-year disease-free and overall survival (OS) rates of entire group were 83% and 86%, respectively. These figures for 27 (56%) patients treated with simple hysterectomy plus radiation were 81% and 83%, respectively. For 21 (44%) patients who were treated with radical hysterectomy without adjuvant therapy, the 5-year disease-free and overall survival rates were 85% and 90%, respectively. When these two groups were compared, survival rates were not significantly different from each other (P = 0.60 for disease-free survival and P = 0.46 for overall survival). In multivariate analysis, only the high grade predicted poor survival significantly (P = 0.04). Eight patients (17%) had recurrence: two local, five distant, and one both local and distant. Initial therapeutic approach was not related with the subsequent site of relapse. Two patients with only local failure were successively treated, but all the six patients who had distant component of relapse died within the same year. Surgical morbidity was seen in six (12.5%) patients. No surgical mortality was seen, and no patient developed a major complication directly related to the radical hysterectomy or lymphadenectomy.
Conclusions: Without adjuvant radiotherapy, initial surgical staging procedure consisting radical hysterectomy and complete pelvic-paraaortic lymphadenectomy achieved excellent survival and minimal morbidity in stage II endometrial cancer. Distant failure was the main problem.