Defining low-risk group before surgical treatment in endometrial cancer: A retrospective review

Endometrial cancer is a heterogeneous malignancy involving many criteria considered in treatment planning. This study analyzed risk factors associated with postoperative outcomes in 250 women diagnosed with endometrioid-type endometrial adenocarcinoma. The aim of this analysis was to identify the subgroup with the lowest risk of extrauterine metastasis, which could be exempted from comprehensive staging surgery. Criteria for admission to the study were endometrioid histology, grade 1 or 2 tumors, and tumor invasion of half the myometrium based on pathology reports. Extrauterine metastases, such as lymph node, fallopian tube, ovary, and omentum involvement, were evaluated. Of the 250 patients, 178 (71.2%) had grade 1 tumors and 72 (28.8%) grade 2 tumors; 152 (60.8%) had a tumor size of 3 cm or less and 98 (39.2%) had a tumor size of more than 3 cm. Eighteen patients (7.2%) had extrauterine metastases. Patients with grade 2 tumors had a higher rate of extrauterine metastases compared with those with grade 1 tumors (15.3% vs 3.9%, P  = .003). Patients with tumor size >3 cm had a higher rate of extrauterine metastases compared with those with tumor size 3 cm or less (13.3% vs 3.3%, P  = .006). In multivariate analysis, grade 2 (hazard ratio = 3.66, 95% confidence interval: 1.33–10.08; P  = .012) and tumor size >3 cm (hazard ratio = 3.83, 95% confidence interval: 1.28–11.39; P  = .016) were independent factors associated with extrauterine metastases. According to the findings of this study, among patients with endometrial cancer with <50% myometrial invasion depth, those with grade 1 tumors and tumor diameters smaller than 3 cm had the lowest rate of extrauterine metastasis. Tumor size was identified as a potential factor in determining the risk of extrauterine metastasis. These results support avoiding comprehensive staging surgery in the subgroup meeting the criteria of having a tumor smaller than 3 cm and a grade 1 endometrioid tumor.