Clinical and pathological features of isolated pulmonary and liver recurrences in endometrial cancer.

Abstract

Objective: To present the clinicopathological features of endometrial cancer (EC) patients with isolated liver or lung metastases and to compare the survival differences after diagnosis of recurrent disease.

 

Material and Methods: The clinical and histopathological data of the patients who were treated with a diagnosis of epithelial EC between January 1993 and May 1993 at Etlik Zubeyde Hanim Teaching and Research Hospital were retrospectively reviewed. Patients with isolated recurrence in liver (ILR) or lung (IPR) were included in the analysis.

Results: The clinical data of 162 patients with recurrent EC were available. Of these, 21 had IPR and 9 had ILR. Patients with ILR presented with more advanced stage, and omental and adnexal involvement was more common compared to patients with IPR. On the other hand, patients with IPR had higher grade disease. Fifty-seven percent of patients with IPR had grade 3 compared to 11% of grade 3 disease in ILR (p=0.02). The median time to recurrence (TTR) was 18 months (range 1-54) in the whole study population. While the median TTR of patients with IPR was 19 months, the median TTR of patients with ILR was 16 months (p=0.204). Both study groups have similar survival. The 1-year post-recurrence survival of IPR and ILR was 66% and 56% (p=0.129), respectively.

Conclusion: Although, isolated liver and lung metastases are the result of hematogenous spread in EC, clinicopathological features of these two recurrence patterns significantly differ. Clinicians should try to categorize these patients separately to better understand the prognostic outcomes. 

Keywords

• endometrial cancer, lung metastasis, liver metastasis, hematogenous spread.

Clinical and pathological features of isolated pulmonary and liver recurrences in endometrial cancer

Öz

References

1. 1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86.
2. 2. Lewin SN, Herzog TJ, Barrena Medel NI, Deutsch I, Burke WM, Sun X, et al. Comparative performance of the 2009 international Federation of gynecology and obstetrics' staging system for uterine corpus cancer. Obstet Gynecol. 2010;116(5):1141-9.
3. 3. Fung-Kee-Fung M, Dodge J, Elit L, Lukka H, Chambers A, Oliver T, et al. Follow-up after primary therapy for endometrial cancer: a systematic review. Gynecol Oncol. 2006;101(3):520-9.
4. 4. Ueda SM, Kapp DS, Cheung MK, Shin JY, Osann K, Husain A, et al. Trends in demographic and clinical characteristics in women diagnosed with corpus cancer and their potential impact on the increasing number of deaths. Am J Obstet Gynecol. 2008;198(2):218 e1-6.
5. 5. Huang HJ, Tang YH, Chou HH, Yang LY, Chao A, Huang YT, et al. Treatment failure in endometrial carcinoma. Int J Gynecol Cancer. 2014;24(5):885-93.
6. 6. Turan T, Ureyen I, Duzguner I, Ozkaya E, Tasci T, Karalok A, et al. Analysis of patients with stage IIIC endometrial cancer. Int J Gynecol Cancer. 2014;24(6):1033-41.
7. 7. Barlin JN, Wysham WZ, Ferda AM, Khoury-Collado F, Cassella DK, Alektiar KM, et al. Location of disease in patients who die from endometrial cancer: a study of 414 patients from a single institution. Int J Gynecol Cancer. 2012;22(9):1527-31.
8. 8. Descamps P, Calais G, Moire C, Bertrand P, Castiel M, Le Floch O, et al. Predictors of distant recurrence in clinical stage I or II endometrial carcinoma treated by combination surgical and radiation therapy. Gynecol Oncol. 1997;64(1):54-8.

9. 9. Bouros D, Papadakis K, Siafakas N, Fuller AF, Jr. Patterns of pulmonary metastasis from uterine cancer. Oncology. 1996;53(5):360-3.
10. 10. Mariani A, Webb MJ, Keeney GL, Calori G, Podratz KC. Hematogenous dissemination in corpus cancer. Gynecol Oncol. 2001;80(2):233-8.
11. 11. Dowdy SC, Mariani A, Bakkum JN, Cliby WA, Keeney GL, Podratz KC. Treatment of pulmonary recurrences in patients with endometrial cancer. Gynecol Oncol. 2007;107(2):242-7.
12. 12. Otsuka I, Ono I, Akamatsu H, Sunamori M, Aso T. Pulmonary metastasis from endometrial carcinoma. Int J Gynecol Cancer. 2002;12(2):208-13.
13. 13. Sohaib SA, Houghton SL, Meroni R, Rockall AG, Blake P, Reznek RH. Recurrent endometrial cancer: patterns of recurrent disease and assessment of prognosis. Clin Radiol. 2007;62(1):28-34; discussion 5-6.
14. 14. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105(2):103-4.
15. 15. WHO handbook for reporting results of cancer treatment1979.
16. 16. Gadducci A, Cavazzana A, Cosio S, C DIC, Tana R, Fanucchi A, et al. Lymph-vascular space involvement and outer one-third myometrial invasion are strong predictors of distant haematogeneous failures in patients with stage III endometrioid-type endometrial cancer. Anticancer Res. 2009;29(5):1715-20.
17. 17. Blecharz P, Urbanski K, Mucha-Malecka A, Malecki K, Reinfuss M, Jakubowicz J, et al. Hematogenous metastases in patients with Stage I or II endometrial carcinoma. Strahlenther Onkol. 2011;187(12):806-11.
18. 18. Tangjitgamol S, Levenback CF, Beller U, Kavanagh JJ. Role of surgical resection for lung, liver, and central nervous system metastases in patients with gynecological cancer: a literature review. Int J Gynecol Cancer. 2004;14(3):399-422.
19. 19. Chi DS, Fong Y, Venkatraman ES, Barakat RR. Hepatic resection for metastatic gynecologic carcinomas. Gynecol Oncol. 1997;66(1):45-51.
20. 20. Wolf RF, Goodnight JE, Krag DE, Schneider PD. Results of resection and proposed guidelines for patient selection in instances of non-colorectal hepatic metastases. Surg Gynecol Obstet. 1991;173(6):454-60.
21. 21. Knowles B, Bellamy CO, Oniscu A, Wigmore SJ. Hepatic resection for metastatic endometrioid carcinoma. HPB (Oxford). 2010;12(6):412-7.