Endometrial karsinomda ESGO risk sınıflandırmasının prognostik faydası: tek merkezli retrospektif bir kohort çalışması

Abstract

Özet Amaç: Merkezimizde endometrial karsinom nedeniyle tedavi edilen hastalarda ESGO risk sınıflandırmasının hastalıksız sağkalım ve genel sağkalımı ne kadar iyi tahmin ettiğini değerlendirmeyi amaçladık. Yöntemler: 2015-2023 yılları arasında ameliyat edilen 61 endometrial karsinomlu hasta üzerinde tek merkezli retrospektif bir analiz gerçekleştirdik. Hasta demografik verileri, klinikopatolojik özellikler, tedavi modaliteleri ve sağkalım sonuçları analiz edildi. Hastalar ESGO risk gruplarına (Düşük, Orta, Yüksek) göre stratifiye edildi. Sağkalım analizi, Log-rank testli Kaplan-Meier eğrileri kullanılarak yapıldı ve bağımsız prognostik faktörleri belirlemek için Cox oransal hazard regresyon modelleri kullanıldı. Bulgular: Tanıdaki medyan yaş 57 idi (aralık: 35-106). En yaygın histolojik alt tip endometrioid idi (%73.8). ESGO sınıflandırmasına göre hastaların %36.1'i düşük riskli, %45.9'u orta riskli ve %18.0'ı yüksek riskli idi. Dokuz hastada (%14.8) nüks görüldü ve en yaygın bölge karaciğerdi (%6.6). Tek değişkenli analizde, tanıdaki yaş, T evresi, adjuvan KT ve ESGO risk sınıflandırması HSS için anlamlı belirteçlerdi. GS için ise yaş ve ESGO sınıflandırması anlamlıydı. Çok değişkenli analizde ise, sadece tanıdaki yaş (HSS için HR: 1.138, %95 GA: 1.040-1.246, p=0.005; GS için HR: 1.148, %95 GA: 1.046-1.260, p=0.004) ve ESGO risk sınıflandırması (HSS için HR: 5.223, %95 GA: 1.788-15.256, p=0.003; GS için HR: 4.742, %95 GA: 1.600-14.060, p=0.005) bağımsız prognostik faktörler olarak kaldı. Kaplan-Meier analizi, yüksek riskli ESGO grubundaki hastaların diğer gruplara kıyasla daha kısa hastalıksız ve genel sağkalıma sahip olduğunu gösterdi (p < 0.0001). Sonuç: Bulgularımız, ESGO risk sınıflandırmasının endometrial karsinomda hem HSS'yi hem de GS'yi güvenilir bir şekilde tahmin edebileceğini düşündürmektedir. Bu sınıflandırmanın klinik uygulamada kullanılması, klinisyenlerin adjuvan tedaviyi ve takibi bireysel hasta riskine göre uyarlamalarına yardımcı olabilir.

Keywords

• Retrospektif analiz
• endometrial kanser
• ESGO risk sınıflandırması
• prognostik faktörler
• adjuvan tedavi

The prognostic utility of the ESGO risk classification in endometrial carcinoma: a single-center retrospective cohort study

Abstract

Aims: We aimed to assess how well the ESGO risk classification predicts disease free and overall survival in patients treated for endometrial carcinoma (EC) at our center. Methods: We conducted a single-center retrospective analysis of 61 patients with EC who underwent surgery between 2015 and 2023. Patient demographics, clinicopathological characteristics, treatment modalities and survival outcomes were analyzed. Patients were stratified according to the ESGO risk groups (low, intermediate, high). Survival analysis was performed using Kaplan-Meier curves with Log-rank tests, and Cox proportional hazards regression models were used to identify independent prognostic factors. Results: The median age at diagnosis was 57 years (range: 35-106). The most common histological subtype was endometrioid (73.8%). According to the ESGO classification, 36.1% of patients were low-risk, 45.9% intermediate-risk, and 18.0% high risk. Recurrence occurred in 9 patients (14.8%), with the liver being the most common site (6.6%). In univariate analysis, age at diagnosis, T stage, adjuvant CT, and ESGO risk classification were significant predictors for DFS. For OS, age and ESGO classification were significant. In the multivariate analysis, only age at diagnosis (HR: 1.138, 95% CI: 1.040-1.246, p=0.005 for DFS; HR: 1.148, 95% CI: 1.046-1.260, p=0.004 for OS) and ESGO risk classification (HR: 5.223, 95% CI: 1.788 15.256, p=0.003 for DFS; HR: 4.742, 95% CI: 1.600-14.060, p=0.005 for OS) remained independent prognostic factors. Kaplan–Meier analysis showed that patients in the high-risk ESGO group had shorter disease-free and overall survival than those in the other groups (p<0.0001). Conclusion: Our findings suggest that the ESGO risk classification can reliably predict both DFS and OS in EC. Applying this classification in clinical practice may help clinicians tailor adjuvant therapy and follow-up according to individual patient risk.

Keywords

• Retrospective analysis
• endometrial cancer
• ESGO risk classification
• prognostic factors
• adjuvant therapy

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