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The contemporary presentation and diagnosis of endometrial cancer recurrence: When, where, and how?

  • Courtney J. Riedinger
    Correspondence
    Corresponding author at: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Medical Center, M210 Starling Loving Hall 320 W 10th Ave, Columbus, OH 43210, United States of America.
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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  • Jenna M. Patterson
    Affiliations
    Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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  • Floor J. Backes
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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  • David O'Malley
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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  • Kristin L. Bixel
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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  • Larry J. Copeland
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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  • David E. Cohn
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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  • Paul J. Goodfellow
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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  • Casey M. Cosgrove
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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Published:September 22, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.09.014

      Highlights

      • The majority of endometrial cancer recurrences are symptomatic, and pain is the most common symptom.
      • Vaginal bleeding was reported in less than a quarter of symptomatic presentations.
      • More than a third of recurrences were diagnosed outside of the oncologic care team and frequently in the emergency room.
      • Seventeen percent of patients were unable to receive treatment for recurrent disease.

      Abstract

      Objective

      To examine patients with confirmed endometrial cancer recurrence; evaluate patterns, presentation, and mode of diagnosis.

      Study design

      A retrospective review of women with endometrial cancer diagnosis between 2014 and 2020. Disease recurrences were evaluated. Medical records were reviewed focusing on presentation at time of recurrence. Relationships were assessed using χ2, Fisher's exact test, t-test, and Wilcoxon test. The Kaplan-Meier product limit was used to estimate survival. Multiple logistic regression analysis was used to assess the impact of covariates.

      Results

      Endometrial cancer recurrence was identified in 201 (11.7%) patients. Sixty percent (120/201) of patients presented with symptoms. Pain was the most common presenting symptom (23.4%, 47/201) and bleeding was reported in <14% (28/201). Patients with symptomatic presentation were less likely to be able to receive treatment for their recurrent disease (76.7% vs 91.3%, p = 0.005). Asymptomatic pelvic exam diagnosed recurrence in 13.4% (27/201) and was more common in patients initially diagnosed with early-stage disease (66.7% vs 34.5% p = 0.001) of endometrioid histology (66.7% vs 36.8%, p = 0.003) without prior adjuvant therapy (48.2% vs 17.9%, p = 0.001). More than1/3 of diagnoses were made by providers outside of the oncologic care team.

      Conclusion

      The majority of women with recurrent endometrial cancer were symptomatic and pain is a common complaint associated with disease recurrence. Patients with symptomatic presentation of disease recurrence were less likely to receive treatment for recurrent disease but this did not result in an overall survival (OS) difference. Given the rising mortality rate of endometrial cancer further work is needed to develop multidisciplinary surveillance strategies that will enable meaningful treatment of disease recurrence.

      Keywords

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