Less-favourable prognosis for low-risk endometrial cancer patients with a discordant pre- versus post-operative risk stratification. (June 2017)

• Record Type: Journal Article
• Authors: Eggink, F.A.; Mom, C.H.; Bouwman, K.; Boll, D.; Becker, J.H.; Creutzberg, C.L.; Niemeijer, G.C.; van Driel, W.J.; Reyners, A.K.; van der Zee, A.G.; Bremer, G.L.; Ezendam, N.P.; Kruitwagen, R.F.; Pijnenborg, J.M.; Hollema, H.; Nijman, H.W.; van der Aa, M.A.
• Is Part Of: European journal of cancer. Volume 78(2017)
• Page Start: 82
• Page End: 90
• Publication Date: 2017-06
• Subjects: Endometrial cancer -- Risk stratification -- Histology -- Clinical decision-making -- Overall survival; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2017.03.010
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: Pre-operative risk stratification based on endometrial sampling determines the extent of surgery for endometrial cancer (EC). We investigated the concordance of pre- and post-operative risk stratifications and the impact of discordance on survival. Methods: Patients diagnosed with EC within the first 6 months of the years 2005–2014 were selected from the Netherlands Cancer Registry (N = 7875). Pre- and post-operative risk stratifications were determined based on grade and/or histological subtype for 3784 eligible patients. Results: A discordant risk stratification was found in 10% of patients: 4% (N = 155) had high pre- and low post-operative risk and 6% (N = 215) had low pre- and high post-operative risk. Overall survival of patients with high pre- and low post-operative risk was less favourable compared to those with a concordant low risk (80% versus 89%, p = 0.002). This difference remained significant when correcting for age, stage, surgical staging and adjuvant therapy (hazard ratio 1.80, 95% confidence interval 1.28–2.53, p = 0.001). Survival of patients with low pre- and high post-operative risk did not differ from those with a concordant high risk (64% versus 62%, p = 0.295). Conclusion: Patients with high pre- and low post-operative risk have a less favourable prognosis compared to patients with a concordant low risk. Pre-operative risk stratifications contain independent prognostic information and should be incorporated into clinical decision-making. Highlights: Pre-operative risk stratifications are used to guide surgical treatment decisions. Concordance between pre- and post-operative risk stratifications was 90%. A discordant risk stratification in low-risk patients negatively impacts survival.