Determination of the impact of prognostic factors on disease-free and overall survival in patients with endometrial cancer; oncological outcomes and retrospective analysis of 1028 cases

Background: Endometrial cancer (EC) incidence is increasing. This study determined prognostic factors for disease-free survival (DFS) and overall survival (OS) in EC patients from a single tertiary center over 22 years. Methods: 1028 patients who underwent surgery for EC between 2000–2022 were evaluated retrospectively using International Federation of Gynecology and Obstetrics (FIGO) 2009 staging. Statistical analysis included Kaplan-Meier survival analysis and Cox proportional hazards regression modeling. Results: 899 (87.7%) patients had endometrioid histology. Grade distribution: 475 (46.2%) grade 1, 371 (36.1%) grade 2, 170 (16.75%) grade 3. FIGO staging: 833 (81.0%) stage I, 71 (7%) stage II, 87 (9%) stage III, 31 (3.0%) stage IV. 368 (35.8%) patients had ≥50% myometrial invasion, 130 (12.7%) cervical involvement, 384 (37.53%) lymphovascular space invasion (LVSI), 80 (7.8%) lymph node metastases. Risk classification: 520 (50.6%) low risk, 195 (19.0%) intermediate risk, 121 (11.8%) high-intermediate risk, 190 (18.6%) high risk. Lower OS and DFS rates were significantly associated with non-endometrioid histology, advanced stage, high grade, high risk classification, ≥50% myometrial invasion, cervical involvement, lymph node metastases, and LVSI (all p < 0.001). In multivariate analysis, independent DFS prognostic factors were FIGO stage (hazard ratios (HR): 4.37 for stage II, HR: 8.68 for stage III, both p < 0.001) and tumor grade (HR: 2.26 for grade 2, p = 0.039; HR: 4.52 for grade 3, p < 0.001). Independent OS prognostic factors were risk classification (HR: 2.12 for intermediate-high risk, p = 0.031; HR: 2.75 for high risk, p = 0.003) and tumor grade (HR: 1.86 for grade 2, p = 0.024; HR: 2.71 for grade 3, p = 0.002). Median follow-up was 84 months. Conclusions: FIGO staging, tumor grade, histopathological type, risk classification, myometrial invasion depth, cervical involvement, LVSI, and lymph node metastases significantly affected survival outcomes. These findings support comprehensive surgical staging and histopathological assessment for prognostic stratification.

Endometrial cancer; Prognostic factor; Disease-free survival; Overall survival; FIGO staging; Lymph node management

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