| Objective:To retrospectively analyze the medical records of patients with endometrial cancer(EC)in the fourth hospital of Hebei Medical University from 2008 to 2017.The aim was to understand the prognosis of patients with surgically treated EC in recent years,compare the overall survival(OS)of EC patients treated by laparoscopic surgery between2008-2012 and 2013-2015,evaluate the impact of different surgical routes on the prognosis of EC patients,analyze the characteristics of stage IA EC patients who relapsed within 2 years after surgery,and summarize the relevant factors affecting the prognosis of patients with EC.Aimed to draw on in the treatment and research of EC.Methods:Through the screening conditions,2619 patients who were pathologically confirmed to have EC after surgical treatment at the gynecological department of the fourth hospital of Hebei Medical University from January 1,2008 to August 31,2017 were collected.The medical records of patients were reviewed in detail using a retrospective analysis,and the postoperative follow-up data of patients were refined by telephone and letter interview and so on,and finally an Excel data sheet was established.SPSS22.0statistical software was used.The Kaplan Meier method was used to estimate survival.Univariate analysis and comparison of survival curves among groups were performed using Log rank test.Multivariate analysis was performed using Logistic and Cox regression models.Baseline data were corrected by1:1 propensity score matching.The counting data were analyzed byχ~2 test,or Fisher’s exact test or Wilcoxon rank sum test.Results are presented as hazard ratio(HR),odds ratio(OR),95%confidence interval(CI)and p-value.P<0.05indicated statistically significant differences.Results:1.From 2008 to 2015,the 5-year OS of patients after surgery was 91.7%,and the 1-year,2-year,3-year and 5-year progression free survival(PFS)after surgery were 95.7%,92.4%,91.8%and 89.1%,respectively.2.The 5-year OS after surgery of patients treated with laparoscopic surgery from 2008 to 2012 and 2013 to 2015 were 95.1%and 94.1%respectively(χ~2=0.417,P=0.519).After matching by 1:1 propensity score,the5-year OS after surgery of patients treated with laparoscopic surgery from2008 to 2012 and 2013 to 2015 were 96.6%and 93.8%respectively(χ~2=1.546,P=0.214).3.From 2008 to 2015,the 5-year OS after surgery of patients treated with laparotomic and laparoscopic surgery were 89.2%and 94.4%respectively(χ~2=23.634,P<0.001),and the 5-year PFS after surgery were 85.8%and92.6%respectively(χ~2=18.072,P<0.001).After matching by 1:1 propensity score,the 5-year OS after surgery were 92.9%and 93.9%(χ~2=0.567,P=0.451)and the 5-year PFS after surgery were 90.9%and 92.5%(χ~2=0.735,P=0.391)for patients treated with laparotomic and laparoscopic,respectively.4.A total of 1912 stage IA patients who underwent surgical treatment between 2008-2017,52 of whom had disease progression within 24 months after surgery.The 2-year postoperative recurrence rate was 2.7%.The proportion of patients with recurrence was statistically different in menopausal status,pathological type,histological grading,presence or absence of lymphovascular space involvement(LVSI),and categories of postoperative adjuvant therapy(P<0.05).When further analyzed by Logistic regression model controlling for confounding factors,it was revealed that preservation of ovary(OR=11.954,95%CI:2.474-57.757,P=0.002),poor histological differentiation(OR=2.439,95%CI:1.195-4.977,P=0.014)and LVSI(OR=3.655,95%CI:1.219-10.962,P=0.021)were independent risk factors for2-year recurrence in stage IA patients.However,the effect of other factors such as postoperative adjuvant therapy on recurrence within 2 years in stage IA patients was not statistically significant(P>0.05).5.After comparing all study variables individually except surgical route by Kaplan Meier survival tables combined with Log rank tests revealed the following:age,menopausal status,gravidity,parity,preoperative carbohydrate antigen 125(CA125)levels,extent of lymph node dissection,pathological type,histological grading,LVSI,surgical-pathologic staging and postoperative adjuvant therapy affected the OS and PFS of patients(P<0.05),whereas the type of hysterectomy alonely affected the PFS of patients(P<0.05).6.To control for confounding factors,the study variables that were statistically significant in univariate analysis were further included in the Cox regression model.We found that age≥60 years old,poor histological differentiation,LVSI and late stage independently increased the risk of death and disease progression in patients(P<0.05),extending the extent of lymph node dissection independently reduced the risk of disease progression in patients(P<0.05),pathological type of non endometrioid carcinomas independently increased the risk of death in patients(P<0.05),and postoperative adjuvant treatment with radiotherapy+chemotherapy independently decreased the risk of death in patients(P<0.05).Conclusions:1.The 5-year OS and PFS after surgery of EC patients in the fourth hospital of Hebei Medical University were 91.7%and 89.1%,respectively,with an overall good prognosis.2.EC patients treated by laparoscopic surgery in the fourth hospital of Hebei Medical University had a good and stable prognosis,and were no worse than those treated by laparotomic surgery,so it can continue to use safely.3.Ovarian preservation,poor histological differentiation,and LVSI are independent risk factors for recurrence within 2 years after surgery of patients for stage IA EC,therefore,the surgery option of ovarian preservation should be considered carefully before operation.However,for patients with stage IA EC with poor histological differentiation and/or LVSI,excluding patients with ovarian preservation,whether additional adjuvant therapy is needed after operation still needs to be verified by large sample studies.4.In the process of treatment of EC,we should focus on patients with age≥60 years old,with non endometrioid carcinomas,poor histological differentiation,LVSI and late stage,and adopt targeted and individualized treatment.For high-risk patients,lymph node dissection may be extended,and radiotherapy+chemotherapy may be chosen as the preferred adjuvant treatment modality after surgery. |
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