What are the recurrence rates of endometrial cancer by stage and risk factors?

Recurrence Rates of Endometrial Cancer by Stage and Risk Factors

The recurrence rates of endometrial cancer vary significantly by stage and risk factors, with overall recurrence rates of approximately 15% for clinical stage I and II disease, with most recurrences occurring within the first 3 years after treatment. 1

Recurrence Rates by Stage

Stage I

• Stage IA (invasion <50% of myometrium): 5-year survival rate of 89.6% with corresponding recurrence risk of approximately 10.4% 1
• Stage IB (invasion ≥50% of myometrium): 5-year survival rate of 77.6% with corresponding recurrence risk of approximately 22.4% 1
• For low-risk stage IA grade 1 endometrial cancer specifically, recurrence rates are approximately 7.65% 2

Stage II

• Contributes to the overall 15% recurrence rate for early-stage disease 1
• Higher recurrence rates compared to Stage I, particularly with cervical stromal invasion 1

Stage III

• Stage IIIC1 (positive pelvic nodes): 5-year survival rate of 57%, indicating recurrence risk of approximately 43% 1
• Stage IIIC2 (positive para-aortic nodes): 5-year survival rate of 49%, indicating recurrence risk of approximately 51% 1

Stage IV

• Highest recurrence rates, with 5-year survival rates significantly lower than earlier stages 1

Recurrence Rates by Risk Classification

Low-Risk Endometrial Cancer

• Stage IA (G1-G2) with endometrioid type (dMMR and NSMP) and no or focal LVSI 1
• Stage I/II POLEmut cancer 1
• Recurrence rates are generally low, approximately 5-10% 3

Intermediate-Risk Endometrial Cancer

• Stage IA G3 with endometrioid type (dMMR and NSMP) and no or focal LVSI 1
• Stage IA non-endometrioid type without myometrial invasion and no or focal LVSI 1
• Stage IB (G1-G2) with endometrioid type (dMMR and NSMP) and no or focal LVSI 1
• Moderate recurrence rates, higher than low-risk but lower than high-risk 1

High-Intermediate Risk Endometrial Cancer

• Stage I endometrioid type (dMMR and NSMP) any grade with substantial LVSI 1
• Stage IB G3 with endometrioid type (dMMR and NSMP) regardless of LVSI 1
• Stage II endometrioid type (dMMR and NSMP) 1
• Higher recurrence rates than intermediate-risk 1

High-Risk Endometrial Cancer

• All stages with p53-abnormal tumors and myometrial invasion 1
• All stages with serous or undifferentiated carcinoma with myometrial invasion 1
• All stage III and IVA with no residual tumor 1
• Grade 3 endometrioid tumors have recurrence rates of approximately 36.1% 4
• Highest recurrence rates among all risk categories 1

Recurrence Patterns and Timing

• 91% of recurrences occur within the first 5 years after treatment (early recurrence) 5
• 9% of recurrences occur beyond 5 years (late recurrence) 5
• Most recurrences (87.5%) in high-grade endometrial cancer occur within the first 3 years 6
• 50-70% of recurrences are symptomatic 1
• Recurrence patterns: local-regional (37.5%) vs. distant (62.5%) in grade 3 endometrioid tumors 6

Key Risk Factors for Recurrence

Histopathological Factors

• Histological type: 5-year survival rates vary significantly - endometrioid (83%) vs. clear cell (62%) vs. papillary serous (53%) 1
• Tumor grade: Grade 1 (7.7%), Grade 2 (10.5%), Grade 3 (36.1%) recurrence rates 4
• Lymphovascular space invasion (LVSI): 5-year overall survival of 64% with LVSI vs. 88% without LVSI 1
• Depth of myometrial invasion: no invasion (9.8%), <50% invasion (7.4%), ≥50% invasion (29.6%) recurrence rates 4
• Tumor size: ≤2 cm (7%), >2 cm (17.3%) recurrence rates 4

Molecular Factors

• Molecular classification significantly impacts recurrence risk: p53-abnormal, POLEmut, dMMR, and NSMP subgroups have different prognoses 1
• CTNNB1 mutation and L1CAM expression are significant risk factors for recurrence in low-risk EC 3

Lymph Node Status

• Negative lymph nodes: 8.3% recurrence rate 4
• Positive lymph nodes: 47.6% recurrence rate 4

Other Factors

• Age: mean age of 68.6 years in patients with recurrence vs. 60.3 years without recurrence 4
• Time from biopsy to surgery ≥6 months increases recurrence risk 2
• Peritoneal cytology: negative (9.4%) vs. positive (26.3%) recurrence rates 4

Clinical Implications

• Most recurrences occur within the first 3 years after treatment, justifying intensive surveillance during this period 1
• Late recurrences (>5 years) are more common in patients with low-grade, early-stage disease with <50% myometrial invasion 5
• Surgical management may improve prognosis in cases of late recurrence 5
• Patients with recurrence have significantly worse outcomes (5-year overall survival of 60% vs. 95% in those without recurrence) 2

Understanding these recurrence patterns and risk factors is crucial for developing appropriate surveillance strategies and considering adjuvant therapy options for patients with endometrial cancer.