Background & objective: A number of prognostic factors have been evaluated in endometrial carcinoma. Among them, only a few factors have been recognized as major adverse factors affecting prognosis independently. This study was to explore the independent prognostic factors in endometrial carcinoma.
Methods: A total of 265 patients who accepted primary surgical treatment in our hospital from Jan. 1990 to Dec. 2000 were studied retrospectively. Prognostic factors were analyzed using univariate model and multivariate regression model.
Results: The 5-year recurrence-free survival rate of all patients was 83.3%, and 5-year overall survival rate was 84.3%. The univariate model revealed that clinical stage, pathological stage, pathologic grade, pathologic subtype, depth of muscularis invasion, cervical invasion, lymph node metastasis, peritoneal cytology, lymph-vascular invasion, and adnexa metastasis significantly associated with 5-year recurrence-free survival, and 5-year overall survival (P< 0.05), while age, and complications have no significant association with prognosis (P >0.05). However,on multivariate regression analysis, only pathohistological stage, pathologic grade, depth of muscularis invasion, and cervical invasion significantly correlated with 5-year recurrence-free survival, and 5-year overall survival (P< 0.05); clinical stage correlated with 5-year recurrence-free survival significantly (P< 0.001), but not with 5-year overall survival (P=0.074). Hematogenous dissemination rate of patients with muscularis invasion of >50% was significantly higher than that with muscularis invasion of <or=50% (12.9% vs 0.6%, P< 0.001). Lymphatic failure rate of patients with cervical invasion was significantly higher than that without cervical invasion (21.1% vs 3.6%, P< 0.001).
Conclusions: FIGO stage, pathologic grade, depth of muscularis invasion, and cervical invasion are independent prognostic factors in endometrial carcinoma. Comparing with clinical stage, pathohistological stage could assess prognosis more objectively. Deep muscularis invasion is the strongest predictor of hematogenous dissemination; and cervical invasion increases the lymphatic failure rate.