Why routine clinical follow-up for patients with early stage endometrial cancer is not always necessary: A study on women in South Wales

Abstract

Objective: This study aimed to examine the existing methods of follow-up in women who have undergone treatment of early endometrial carcinoma in South Wales and to assess if they are appropriate. Design: This study used a retrospective analysis of follow-up data. Setting: This study was performed in the Virtual Gynaecological Oncology Centre, South Wales, United Kingdom. Sample: This study sample is composed of 552 women. Methods: Data regarding follow-up were collected retrospectively from patient case notes and computerized data systems. Data were analyzed using the Pearson W2 test, Cox proportional hazard regression analysis, and Kaplan-Meier curves. Main Outcome Measures: This study aimed to determine whether routine follow-up was beneficial in detecting disease recurrence and whether outcome was influenced by routine follow-up. Results: Between January 1, 2000, and December 31, 2010, 552 women were treated for early stage endometrial carcinoma. The 5-year survivalwas 81%, and the 5-year progressionfree survival was 77%. Of these 552 women, 81 (15%) developed a disease recurrence; the majority (61/81 [75%]) recurred within 3 years. The median survival was 35 months comparedwith 47months in patientswho did not develop a recurrence.Of the 81 patients, 73 (90%) were symptomatic and only 5 patients were truly asymptomatic at follow-up. The most important and significant prognostic factor was "recurrent disease" with overall survival (hazard ratio, 2.20; P G 0.001; 95% confidence interval, 1.75-2.65) and progression-free survival (hazard ratio, 2.52; P G 0.001; 95% confidence interval, 2.09-2.95). "Asymptomatic recurrence" was not an independent predictor of outcome. Conclusions: Routine follow-up for early endometrial cancer is not beneficial for patients because most were symptomatic at the time of detection. It does not significantly improve the outcome.We propose altering the follow-up time regimen and adopting alternative follow-up strategies for women in South Wales. Copyright © 2014 by IGCS and ESGO.