Prognostic factors associated with recurrence in clinical stage I adenocarcinoma of the endometrium

Two hundred sixty-four consecutive patients with clinical stage I endometrial adenocarcinoma who underwent primary surgical therapy between July 1979 and August 1988 were followed prospectively and evaluated for disease recurrence for 8–112 months (mean 51.5). Thirty-three patients (12.5%) developed recurrence or died of disease. In univariate statistical analysis, prognostic factors significantly associated with disease recurrence were as follows: age (mean 68.6 years with versus 60.3 years without recurrence; P = .0001); histology (adenocarcinoma 8.8%, adeno-squamous 35.7%, papillary 25%, clear-cell 57.1%; P < .0001); tumor grade (grade 1, 7.7%, grade 2, 10.5%, grade 3, 36.1%; P < .0001); depth of myometrial invasion (none 9.8%, less than one-half 7.4%, one-half or greater 29.6%; P = .0001); lymph node status (negative 8.3%, positive 47.6%; P < .0001); non-nodal extrauterine disease spread (absent 11.0%, present 50%; P = .0003); peritoneal cytology (negative 9.4%, positive 26.3%; P = .004), and tumor size (2 cm or less 7%, greater than 2 cm 17.3% P = .05). Cervical extension and uterine size had no significant effect on recurrence. Using multivarlate analysis, grade 3 tumor (P = .002), advancing age (P = .004), lymph node metastasis (P = .006), and presence of extrauterine disease spread other than lymph node metastasis (P = .038) were the only variables significantly associated with disease recurrence or death. This study supports the new International Federation of Gynecology and Obstetrics surgical staging system for endometrial cancer. Recurrence developed in 7.4% (15 of 202) of patients with surgical stage I disease, none of seven patients with surgical stage II disease, and 32.7% (18 of 55) of patients with surgical stage III disease (P < .0001).