Clinical outcome of recurrent endometrial cancer: analysis of post-relapse survival by pattern of recurrence and secondary treatment.

INTRODUCTION: Recurrence of endometrial cancer is an important clinical challenge, with median survival rarely exceeding 12 months. The aim of this study was to analyze patterns of endometrial cancer recurrence and associations of these patterns with clinical outcome. METHODS: The study included patients with endometrial cancer who underwent primary surgical treatment with or without adjuvant treatment between July 2004 and June 2017 at the Gynaecologic Oncology Unit of one of three tertiary hospitals of the Catholic University Network in Italy with complete follow-up data available. Information on the date and pattern of recurrence was retrieved for each relapse. Post-relapse survival was recorded as the time from the date of recurrence to the date of death or last follow-up. Survival probabilities were compared using log rank tests, and associations of clinico-pathological characteristics with post-relapse survival were tested using Cox's regression models. RESULTS: A total of 1503 patients were included in the analysis. We identified 210 recurrences (14.0%) and 105 deaths (7.0%) at a median follow-up of 34 months (range 1-162). One hundred and fifty-eight recurrences (78.1%) occurred during the first two years of follow-up. Most recurrences were multifocal (n=121, 57.6%) and involved extrapelvic sites (n=38, 65.7%). Parameters associated with post-relapse survival in the univariate analysis included histotype, grade, time to recurrence, pattern of recurrence, number of relapsing lesions, and secondary radical surgery. Only the pattern of recurrence and secondary radical surgery were independent predictors of post-relapse survival in the multivariate analysis (p=0.025 and p=0.0001, respectively). CONCLUSION: Lymph node recurrence and the feasibility of secondary radical surgery were independent predictors of post-relapse survival in patients with recurrent endometrial cancer.

Secondary cytoreductive surgery in recurrent uterine leiomyosarcoma: a multi-institutional study.

INTRODUCTION: Uterine leiomyosarcoma (uLMS) represents a rare gynecological malignancy with high incidence of recurrence. Evidence in literature about the management of recurrent uLMS is limited, and the role of secondary cytoreduction has been evaluated in small and heterogeneous populations. The objective of this study is to assess the prognostic role of secondary cytoreductive surgery and its related complications in a large and homogeneous group of patients. METHODS: All consecutive patients who underwent surgery for recurrent uLMS between 01/2010-01/2018 at four Italian tertiary referral centers, were included. Relevant demographic and clinico-pathologic data were retrieved. Survival curves were estimated by Kaplan-Meier method and compared by log-rank test. Cox-proportional hazard model was used to assess the effect of the most predictive prognostic variables. RESULTS: 38 patients with recurrent uLMS were treated with secondary cytoreductive surgery in the study period. Recurrence presented as isolated disease in 17 (44.7%) cases. Bowel, bladder and upper abdominal surgery was performed in 50.0%, 18.4% and 28.9% of the cases, respectively. No residual tumor was the final surgical result in 35 (92.1%) patients. Median hospital stay was 7 days (range, 1-24). No women had major intra-operative and 4 (33.3%) had major post-operative complications. No patient died within 30-days from the secondary cytoreduction. Median time to the first cycle of adjuvant chemotherapy was 41-days (range, 29-78). Median recurrence-free survival was 16.0months (95%CI,11.6 to 26.1). 5-year overall survival (OS) was 76% (95%CI,53 to 89%). Time to first recurrence >12months significantly affected OS (p=0.04). DISCUSSION: Secondary cytoreduction in recurrent uLMS often requires complex and extensive surgical procedures. Referral to tertiary centers guarantees low peri-operative morbidity, short length of hospitalization and median time to chemotherapy within the standard of care. Therefore, secondary cytoreduction to no residual disease is an option that may be considered in recurrent uLMS, especially in patients with time to first recurrence >12months.

Risk of ovarian recurrence after ovarian conservation in early-stage cervical cancer treated with radical surgery: A propensity match analysis.

INTRODUCTION: The primary aim of the present study was to assess the incidence of ovarian metastasis/recurrence and the survival of patients undergoing radical hysterectomy with ovarian conservation (CONSERV) versus oophorectomy (OOPHOR). Secondary aim was to assess the incidence and the characteristics of menopausal symptoms in both groups. MATERIALS AND METHODS: Retrospective, multi-center, observational cohort study including patients <50 years with clinical FIGO 2009 stage IA1-IB1/IIA1 cervical carcinoma, treated by primary surgical treatment between 02/2007 and 07/2019. One-to-one case-control matching was used to adjust the baseline prognostic characteristics in survival analysis. RESULTS: 419 patients were included. 264 in the OOPHOR (63.0%) and 155 (37.0%) in the CONSERV group. Ovarian transposition was performed in 28/155 (18.1%) patients. 1/264 (0.4%) patient had ovarian metastasis from endocervical adenocarcinoma. After propensity-matching, 310 patients were included in the survival analysis (155 per group). 5-year disease-free survival of patients undergoing CONSERV versus OOPHOR was 90.6% versus 82.2%, respectively (p = 0.028); 5-year overall survival was 94.3% versus 90.8%, respectively (p = 0.157). Two patients (1.3%) developed recurrence on the conserved ovary. CONSERV represented an independent protective factor of recurrence (HR:0.361, 95%CI 0.169-0.769; p = 0.008). 28 (20.6%) in the CONSERV group versus 116 (60.4%) in the OOPHOR group complained of menopausal symptoms during follow up (p < 0.001). HRT was prescribed to 12.0% of patients (median HRT time was 20 months). CONCLUSION: CONSERV was associated with reduced risk of recurrence and menopausal symptoms in early-stage cervical cancer. As the risk of ovarian metastasis and ovarian recurrence is relatively low, CONSERV in pre-menopausal women has to be considered.