The routine method of follow-up for women with endometrial cancer who had been managed surgically by hysterectomy is clinical examination at a scheduled follow-up appointment at defined intervals. The main rationale for routine follow-up of asymptomatic women is that early detection of recurrent disease and subsequent salvage therapy may improve survival. However, this has not been demonstrated with routine follow-up among women with endometrial cancer, particularly in low-risk groups. A number of studies found no improved survival among patients who developed a recurrent disease detected during their normal routine follow-up compared with patients who developed a “symptomatic recurrence” detected between routine appointments.
The aim of this retrospective study was to determine whether routine follow-up was beneficial in detecting disease recurrence in women with early endometrial cancer and whether outcome was influenced by routine follow-up. Participants had undergone surgical management (hysterectomy) for early-stage endometrial cancer between 2000 and 2010 in South East Wales, United Kingdom. Data from 552 women were available for analysis. Follow-up data were collected from patient case notes and computerized data systems. Data analysis was performed using the Pearson χ2 test, Cox proportional hazard regression analysis, and Kaplan-Meier curves.
The median follow-up interval was 49.5 months (range, 2–140 months).
The 5-year overall survival rate was 81%, and the 5-year progression free survival rate was 77%. Fifteen percent (81/552) of the women developed a disease recurrence; 75% (61/81) had a recurrence within 3 years, and 90% (73/81) presented with symptoms. The median survival for patients with recurrent disease was 35 months compared with 47 months in patients who did not develop a recurrence. Less than 1% (5/552) of the women had a “true asymptomatic recurrence” detected at a scheduled follow-up appointment.
Recurrent disease was the most important independent prognostic factor for survival; the hazard ratio for overall survival was 2.20 (95% confidence interval, 1.75–2.65; P < 0.001), and the hazard ratio for progression-free survival was 2.52 (95% confidence interval, 2.09–2.95; P < 0.001). “Asymptomatic recurrence” was not an independent prognostic indicator for survival.
These data show that routine follow-up of patients with early-stage endometrial cancer does not improve survival because most are symptomatic at the time of detection. Alternate follow-up strategies are needed.