Recurrence and Survival Rates of Patients Who Undergo Minimally Invasive Surgery for Endometrial Carcinoma with Different Prognostic Risk Groups

Figures & data

Table 1. Clinopathological characteristics of patients.

Variable	MIS (n = 196)	Open (n = 469)	P-value
Age	53 (49, 59)	53 (48, 58)	0.581
BMI (kg/m^2)	21.8 (21.1, 22.6)	22.0 (21.2, 23.0)	0.016
Comorbidity			0.519
No	109 (55.6%)	248 (52.9%)
Yes	87 (44.4%)	221 (47.1%)
Histology			0.082
Endometrioid	165 (84.2%)	403 (85.9%)
Carcinosarcoma	1 (0.5%)	6 (1.3%)
Clear Cell	8 (4.1%)	10 (2.1%)
Serous	9 (4.6%)	9 (1.9%)
Mixed	13 (6.6%)	36 (7.7%)
Other	0 (0.0%)	5 (1.1%)
Different prognostic risks			0.351
Low-risk	76 (38.8%)	201 (42.9%)
Intermediate-risk	45 (23.0%)	81 (17.3%)
Intermediate-high-risk	42 (21.4%)	98 (20.9%)
High-risk	33 (16.8%)	89 (19.0%)
FIGO stage			0.154
IA	97 (49.5%)	237 (50.5%)
IB	52 (26.5%)	98 (20.9%)
II	30 (15.3%)	74 (15.8%)
III	17 (8.7%)	55 (11.7%)
IVA	0 (0.0%)	5 (1.1%)
Type of hysterectomy			0.202
RH	148 (75.5%)	375 (80.0%)
SH	48 (24.5%)	94 (20.0%)
Depth of myometrial invasion			0.049
>50%	77 (39.3%)	146 (31.1%)
≤50%	104 (53.1%)	264 (56.3%)
Endometrium only	15 (7.7%)	59 (12.6%)
Lymph node sampling			0.000
Pelivic	151 (77.0%)	373 (79.5%)
Pelvic + Paraaortic	31 (15.8%)	18 (3.8%)
No lymph node sampling	14 (7.1%)	78 (16.6%)
Grade			0.636
G1	49 (25.0%)	134 (28.6%)
G2	85 (43.4%)	196 (41.8%)
G3	62 (31.6%)	139 (29.6%)
LN metastasis			0.301
No	185 (94.4%)	432 (92.1%)
Yes	11 (5.6%)	37 (7.9%)
Tumor size			0.261
≤5	154 (78.6%)	386 (82.3%)
>5	42 (21.4%)	83 (17.7%)
LVSI positive			0.281
No	157 (80.1%)	392 (83.6%)
Yes	39 (19.9%)	77 (16.4%)
Cervical stromal invasion depth			0.113
No	161 (82.1%)	353 (75.3%)
≤50%	14 (7.1%)	56 (11.9%)
>50%	21 (10.7%)	60 (12.8%)
Radiotherapy			0.004
No	121 (61.7%)	342 (72.9%)
Yes	75 (38.3%)	127 (27.1%)
Chemotherapy			0.480
No	124 (63.3%)	283 (60.3%)
Yes	72 (36.7%)	186 (39.7%)
Recurrences			0.000
No	162 (82.7%)	438 (93.4%)
Yes	34 (17.3%)	31 (6.6%)
Survival state			0.138
Survival	177 (90.3%)	439 (93.6%)
Death	19 (9.7%)	30 (6.4%)

MIS = minimally invasive surgery, BMI = body mass index, FIGO = international federation of gynecology and obstetrics, RH = radical hysterectomy, SH = simple hysterectomy, LVSI = lymphovascular space invasion.

Figure 1. Recurrence rates of patients with different prognostic risk groups. (A) The MIS group. (B) The open surgery group.

Figure 2. Recurrences site of patients with different surgical approaches. (A) The MIS group. (B) The open surgery group.

Table 2. Oncologic outcomes of patients.

Variable	MIS (n = 196, %)	Open (n = 469, %)	P-value
Recurrences total			0.000
Yes	34 (17.3%)	31 (6.6%)
No	162 (82.7%)	438 (93.4%)
Recurrences site
Vaginal	5 (2.6%)	7 (1.5%)	0.350
Pelvis	4 (2.0%)	7 (1.5%)	0.863
Lymph node	11 (5.6%)	10 (2.1%)	0.019
Distant metastasis	14 (7.1%)	7 (1.5%)	0.003
Recurrences by different prognostic risks
Low-risk	1 (0.5%)	4 (0.9%)	0.979
Intermediate-risk	2 (1.0%)	2 (0.5%)	0.723
Intermediate-high-risk	15 (7.7%)	8 (1.7%)	0.000
High-risk	16 (8.2%)	17 (3.6%)	0.014
Median follow-up (months)	62 (58, 72)	80 (64, 98)	0.000

MIS = minimally invasive surgery

Table 3. Univariate analysis of influence on recurrence.

	Recurrence		Z/X2	P
	No (n = 600)	Yes (n = 65)
Age	53 (48, 58)	54 (50, 59)	−1.326	0.185
BMI (kg/m^2)	21.9 (21.1, 22.9)	21.9 (21.1, 22.9)	−0.230	0.818
Comorbidity			0.661	0.416
No	319 (89.4%)	38 (10.6%)
Yes	281 (91.2%)	27 (8.8%)
Histology			9.418	0.093
Endometrioid	520 (91.5%)	48 (8.5%)
Carcinosarcoma	5 (71.4%)	2 (28.6%)
Clear Cell	15 (83.3%)	3 (16.7%)
Serous	14 (77.8%)	4 (22.2%)
Mixed	41 (83.7%)	8 (16.3%)
Other	5 (100.0%)	0 (0.0%)
Different prognostic risksv			72.248	0.000
Low-risk	272 (98.2%)	5 (1.8%)
Intermediate-risk	122 (96.8%)	4 (3.2%)
Intermediate-high-risk	116 (82.9%)	24 (17.1%)
High-risk	90 (73.8%)	32 (26.2%)
FIGO stage			62.269	0.000
Ia	327 (97.9%)	7 (2.1%)
Ib	133 (88.7%)	17 (11.3%)
II	86 (82.7%)	18 (17.3%)
III	50 (69.4%)	22 (30.6%)
IVvA	4 (80.0%)	1 (20.0%)
Type of hysterectomy			0.001	0.969
RH	472 (90.2%)	51 (9.8%)
SH	128 (90.1%)	14 (9.9%)
Surgical approach			18.070	0.000
MIS	162 (82.7%)	34 (17.3%)
Open	438 (93.4%)	31 (6.6%)
Depth of myometrial invasion			26.128	0.000
>50%	184 (82.5%)	39 (17.5%)
≤50%	342 (92.9%)	26 (7.1%)
Endometrium only	74 (100.0%)	0 (0.0%)
Lymph node sampling			17.099	0.000
Pelivic	475 (90.6%)	49 (9.4%)
Pelvic + Paraaortic	36 (73.5%)	13 (26.5%)
NO	89 (96.7%)	3 (3.3%)
Grade			51.990	0.000
G1	181 (98.9%)	2 (1.1%)
G2	262 (93.2%)	19 (6.8%)
G3	157 (78.1%)	44 (21.9%)
LN metastasis			19.754	0.000
No	566 (91.7%)	51 (8.3%)
Yes	34 (70.8%)	14 (29.2%)
Tumor size			3.735	0.053
≤5	493 (91.3%)	47 (8.7%)
>5	107 (85.6%)	18 (14.4%)
LVSI positive			66.292	0.000
No	519 (94.5%)	30 (5.5%)
Yes	81 (69.8%)	35 (30.2%)
Cervical stromal invasion depth			18.291	0.000
No	476 (92.6%)	38 (7.4%)
≤50%	61 (87.1%)	9 (12.9%)
>50%	63 (77.8%)	18 (22.2%)
Radiotherapy			39.934	0.000
No	440 (95.0%)	23 (5.0%)
Yes	160 (79.2%)	42 (20.8%)
Chemotherapy			31.014	0.000
No	388 (95.3%)	19 (4.7%)
Yes	212 (82.2%)	46 (17.8%)
Survival state			235.612	0.000
Survival	587 (95.3%)	29 (4.7%)
Death	13 (26.5%)	36 (73.5%)

MIS = minimally invasive surgery, BMI = body mass index, FIGO = international federation of gynecology and obstetrics, RH = radical hysterectomy, SH = simple hysterectomy, LVSI = lymphovascular space invasion.

Table 4. Multivariate logistic regression analysis of recurrence.

	B	S.E.	Wald	df	Sig.	Exp(B)	95% CI for EXP(B)
							Lower	Upper
High-risk			34.349	3	0.000
Low-risk	−2.516	0.526	22.876	1	0.000	0.081	0.029	0.226
Intermediate-risk	−2.277	0.577	15.568	1	0.000	0.103	0.033	0.318
Intermediate-high-risk	−0.309	0.336	0.844	1	0.358	0.734	0.380	1.419
Surgical approach	1.359	0.304	19.945	1	0.000	3.893	2.144	7.070
LVSI positive	−1.406	0.311	20.391	1	0.000	0.245	0.133	0.451
Constant	−0.806	0.275	8.611	1	0.003	0.447

LVSI = lymphovascular space invasion.

Figure 3. Nomogram for recurrence risk.

Figure 4. Overall survival in different prognostic risk groups. (A) Overall survival in low-risk group. (B) Overall survival in intermediate-risk group. (C) Overall survival in intermediate-high-risk group. (D) Overall survival in high-risk group.

Figure 5. Disease free survival in different prognostic risk groups. (A) Disease free survival in low-risk group. (B) Disease free survival in intermediate-risk group. (C) Disease free survival in intermediate-high-risk group. (D) Disease free survival in high-risk group.

Data availability statement

Data are available upon reasonable request. The data that supporting the findings of this study is available from the corresponding author upon reasonable request.