Open AccessSurvival after stage IA endometrial cancer; can follow‐up be altered? A prospective nationwide Danish survey
Author(s) -
LAJER HENRIK,
ELNEGAARD SANDRA,
CHRISTENSEN RENÉ D.,
ORTOFT GITTE,
SCHLEDERMANN DORIS E.,
MOGENSEN OLE
Publication year - 2012
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/j.1600-0412.2012.01438.x
Subject(s) - medicine , endometrial cancer , hazard ratio , histopathology , gynecology , proportional hazards model , stage (stratigraphy) , hysterectomy , prospective cohort study , survival rate , cancer , cancer registry , population , danish , confidence interval , adjuvant therapy , surgery , pathology , paleontology , linguistics , philosophy , environmental health , biology
Objective . To present Danish national survival data on women with early stage endometrial cancer and use these data to discuss the relevance of postoperative follow‐up. Design . Prospective study. Setting . Danish Endometrial Cancer Study (DEMCA). Population . Five hundred and seventy‐one FIGO stage IA (1988 classification) endometrial cancer patients prospectively included between 1986 and 1999. All patients had total abdominal hysterectomy and bilateral salpingo‐oophorectomy without adjuvant therapy. Methods . The patient and the disease characteristics were drawn from the DEMCA database with cross‐references to the national death registry and the national pathology database. Statistical methods included Kaplan–Meier, log‐rank and Cox regression analysis. Main outcome measures . Survival rates in relation to histopathology. Results . The five year overall survival rate was 88.9% and five year disease‐specific survival was 97.3%. Patients with low‐ (91.8%) and high‐risk histopathology (8.2%) were compared. The age‐adjusted overall and disease‐specific survival differed significantly between women with low‐ and high‐risk histopathology ( p = 0.039 and p = 0.004, respectively). The disease‐specific survival adjusted for age between patients with well‐differentiated endometrioid tumors differed from those with moderately differentiated tumors ( p = 0.008, hazard ratio = 3.75, 95% confidence interval 1.41–10.00). Recurrence data were available on 464 patients. Twenty‐three (3.9%) experienced recurrence. Of these recurrences, 15 of 23 (65%) were vaginal. Death from recurrence was observed in nine of 23 (39%) patients, and five of these nine had vaginal recurrences. Conclusions . Women with FIGO stage IA endometrial cancer have a very high disease‐specific five year survival. Survival was related to histopathology. Follow‐up at a highly specialized tertiary care center for patients with an extremely good prognosis may be questioned.