Clinicopathological Predictors and Patterns of Recurrence in Endometrial Cancer: A Retrospective Cohort Study

Abstract

Background: Endometrial cancer is the most common gynaecological malignancy in developed countries and its incidence is increasing in Malaysia. Despite favourable outcomes, disease recurrence remains a significant cause of morbidity and mortality. Local data on recurrence patterns and predictors among Malaysian patients are limited. Aim: This study aimed primarily to identify clinicopathological factors associated with recurrence and, secondarily, to describe the incidence, timing, and patterns of recurrence among patients with endometrial cancer treated at a tertiary referral centre in southern Malaysia. Methods: A retrospective cohort study was conducted among patients with histologically confirmed endometrial cancer who underwent primary treatment at Hospital Sultan Ismail, Johor, between January 2018 and December 2022. Demographic, clinicopathological, and treatment-related data were extracted from medical records. Factors associated with recurrence were evaluated using bivariable analyses and logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated to identify factors independently associated with recurrence. Results: A total of 110 patients were included, of whom 25 (22.7%) developed recurrent disease. On multivariable analysis, advanced FIGO stage (III–IV) was the only factor independently associated with recurrence (AOR 3.56, 95% CI 1.17–10.88; p = 0.026). Type II histology demonstrated a strong but non-significant association with recurrence (AOR 4.05, 95% CI 0.89–18.37; p = 0.070). Among recurrent cases, the median recurrence-free interval was 15 months (IQR 5.5–27.0 months), while multiple-site recurrence (52.0%) was the most common pattern. On bivariable analysis, recurrence was significantly associated with non-endometrioid histology, high tumour grade, advanced FIGO stage, lymphovascular space invasion (LVSI), adnexal involvement, serosal involvement, pelvic lymph node metastasis, oestrogen receptor positivity and p53 overexpression (all p < 0.05). Conclusion: Approximately one in five patients developed recurrent disease. Advanced FIGO stage was the factor most strongly associated with recurrence in this cohort. The median recurrence-free interval was 15 months, and recurrences predominantly involved multiple or distant sites, supporting consideration of risk-adapted follow-up strategies among women with advanced-stage disease.