Recurrent patterns after postoperative radiotherapy for early stage endometrial cancer: A competing risk analysis model

Objective The study aimed to evaluate site‐specific recurrent patterns via competing risks analysis and hazard function to provide evidence for adjuvant treatment and follow‐up for early staged endometrial cancer (EC). Methods A total of 858 patients with International Federation of Gynecology and Obstetrics stage I–II EC who received adjuvant radiotherapy at our institution (2000–2017) were included. The radiotherapy modality comprised external beam radiotherapy (EBRT) with or without vaginal brachytherapy (VBT) or VBT alone. Competing risks analysis and hazard rate function were employed to evaluate the recurrence rate according to the ESMO–ESGO–ESTRO risk classification. Results The 5‐year overall survival rates of the low‐risk (LR), intermediate‐risk (IR), high–intermediate risk (HIR), and high‐risk (HR) groups were 96.1%, 95%, 93%, and 89.7%, respectively (p = 0.018). Sixty‐eight patients developed recurrence. The 5‐year incidence of distant recurrence was the highest in the HR group (14.87%), followed by the HIR (7.71%), IR (5.27%), and LR (1.26%) groups (Gray's test, p
The recurrence pattern of endometrial cancer is affected by risk groups and adjuvant treatment. The time‐varying competing risk analysis and hazard function modeling were established. The site‐specific recurrence patterns differed across the risk classification and adjuvant radiotherapy modality. More intense and targeted follow‐up schedules should be administrated to the high‐risk group.