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To identify patients with endometrial cancer at risk for hematogenous,lymphatic,or perito neal recurrence(or combinations of them)who might potentially benefit from target -based therapies.During a 13-year period,915patients had endometrial cancer man aged with hysterectomy and standard adjuvant therapy.On th e basis of our previous regression analyses,depth of myome trial invasion predicted the risk for hematogenous recurrence;positive lymph nodes and cervical stromal invasion predi cted lymphatic recur-rence;stage IV disease or combination of nonendometrioid histology,cervical stromal invasion,positive lymph nodes,and positive peritoneal cytology wa s predictive of peritoneal recurrence.Median follow -up was 66months.Applying the above criteria to the population of 915patients,24%were considered at risk for hematogenous recur -rence,18%for lymphatic recurrence,and 16%for peritoneal recurrence.The respective relapse rates at 5years were28%for patients who were at risk for h ematogenous re-currence,31%for lymphatic recurre nce,and 42%for peritoneal recurrence.This contra sted with less than a 5%recurrence rate in the correspondin g subgroups not at risk for relapse(P <0.001).Collectively,of the 915pa-tients,324(35%)were considered at risk for recurren ce in one or more of the above three sites.Overall,89%of all recurrences were identified in this at -risk group.Impor-tantly,46%of the patients considered at risk subsequently had recurrence in one or more of the th ree sites,compared with only 2%of patients not at risk fo r relapse(P<0.001).Patients at risk for relapse had a 46%probability of experiencing recurrence within 5years despite manage-ment with standard therapy.New targ et -based algorithms for the 35%of endometrial cancer patients deemed at risk should be incorporated in the develo pment of future prospective multimodality clinica l trials predicated on site(s)of recurrence.
To identify patients with endometrial cancer at risk for hematogenous, lymphatic, or perito neal recurrence (or combinations of them) who might potentially benefit from target-based therapies. During a 13-year period, 915patients had endometrial cancer man aged with hysterectomy and standard adjuvant therapy. On e basis of our previous regression analyzes, depth of myometrial invasion predicted the risk for hematogenous recurrence; positive lymph nodes and cervical stromal invasion predi cted lymphatic recur-rence; stage IV disease or combination of nonendometrioid histology, cervical stromal invasion, positive lymph nodes, and positive peritoneal cytology wa predictive of peritoneal recurrence. Median follow-up was 66 months.Applying the above criteria to the population of 915patients, 24% were considered at risk for hematogenous recurrence, 18% for lymphatic recurrence, and 16% for peritoneal recurrence. The respective relapse rates at 5years were 28% for patients who were at risk for h ematogenou s re-currence, 31% for lymphatic recurre nce, and 42% for peritoneal recurrence. this contra sted with less than a 5% recurrence rate in the response in g subgroups not at risk for relapse (P <0.001). Collectively, of the 915 pa-tients, 324 (35%) were considered at risk for recurren ce in one or more of the above three sites. Overall, 89% of all recurrences were identified in this at -risk group. Impor tantly, 46% of the patients considered at risk for had remitted in one or more of the th re sites, compared with only 2% of patients not at risk fo r relapse (P <0.001) .Patients at risk for relapse had a 46% probability of experiencing recurrence within 5years Despite manage-ment with standard therapy. New targ et-based algorithms for the 35% of endometrial cancer patients at at risk should be incorporated in the develoment of future prospective multimodality clinica l trials predicated on site (s) of recurrence.