Erken evre endometrium kanserinde rekürrensi belirleyen prognostik faktörler

Objective: Endometrial carcinoma is the most common gynecologic malignancy in the industrial countries. Most cases with endometrial carcinoma have early stage patients without extrauterine spread and have a favorable prognosis. However, recurrence develops in 10?20% of patients whose disease was confined to the uterus. The purpose of this study is to define recurrence patterns in the early stage endometrium cancer and the clinically substantial prgonostic factors in the population subject to recurrence.Material and Methods: Cases who underwent primary surgery of early stage endometrium cancer at our institution from 2000 to 2011 were reviewed retrospectively (FIGO 1988-stage 1A and 1B, FIGO 2009-stage 1A). Patients were undertaken average 36±2 months lenght of follow up. Within this period, patients who did not detect recurrence are classified as group 1 (n=200); those who detected recurrence are classified as group 2 (n=23). Isolated vagina, pelvic and extrapelvic involvement were determined to be recurrence locations. Age, parity, histological grade, histopathological type, lower uterine segment involvement, lymphovascular space invasion, depth of myometrial invasion, myometrial thickness, percentage of myometrial invasion, tumor free-distance ve tumor size which are important for the prediction of recurrence development were comperatively analyzed between these two groups. While Chi Square test statictics method was used for the comparison of categorical variables; Mann Whitney U test statistic was used for the comparison of continious measurement between groups. Odds Ratio was calculated for risk measurement. p value was taken <0.05 for the statistical significance level among results.Results: Group I consists of 200 patients; Group 2 consists of 23 patients. While the average age of patients for Group I is 56.4; the average age for Group II is found 63.8 (p=0.0001). Whereas the average parity value was found 3.7 for Group I, it was found as average 1.9 for Group II (p=0.0001). While the grade 1 histology rate was found 63.5% for patients in Group I, the grade 1 histology was not found for patients in group II. Patients with grade 3 histology were all detected within Group II (p=0.0001). While the most commonly observed histopathological type with a rate of 96% for Group I was endometrial endometrioid adenocarcinoma; endometrial endometrioid adenocarcinoma displaying squamous differentiation was found to be the most common variant with a rate of 58.3% for Group II (p=0.0001, OR 9.3, 95% CI 3.77-23.28). While Lower Uterine Segment Involvement rate was found 10% for Group I; it was found 86.9% for Group II (p=0.0001, OR 45.0, 95% CI 13.9-144.8). While Lymphovascular Space Invasion rate was found 16.5% for Group I; it was found 86.9% for Group II (p=0.0001, OR 45.0, 95% CI 13.9-144.8 ). While the rate of tumor size over than 2 cm was found 13.5% for Group I; it was found 56.6% for Group II (p=0.0001, OR 6.4, 95% CI 2.6-15.7). While the average of myometrial invasion depth was found 4.2 mm for Group I; the average for Group II was found 5.1 mm (p=0.0001). While the average of myometrial thickness was found 20.3 mm for Group I; the average was found 14.5 mm for (p=0.0001). The percentage of myometrial invasion was found 20.9 for Group I; whereas the percentage was found to be 35.8% for Group II (p=0.0001). While tumor free-distance was found 16.1 mm for Group I; it was found 9.4 mm for Group II (p=0.0001). Isolated vaginal recurrence was the most commonly detected for Group II with a rate of 62.5%.Conclusion: There is a statistically significant correlation between the development of recurrence and following clinicopathologic prognostic factors age, parity, histological grade, histopathological type, lower uterine segment involvement, lymphovascular space invasion, tumor size, tumor free-distance, depth of myometrial invasion, myometrial thickness and percentage of myometrial invasion which are in the early stage endometrium cancer.Keywords: Early stage endometrium cancer, prognostic factors, recurrence