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    ENDOMETRIAL CANCER – A 10-YEAR REVIEW OF CLINICOPATHOLOGICAL FEATURES AND TREATMENT OUTCOME
    (DADZIE, MARY – ANN, 2022-03-01) DADZIE, MARY – ANN
    Although recently there have been significant advances in the understanding of endometrial cancer biology, the role of lymphadenectomy, adjuvant radiation, and chemotherapy is still not well defined. As a result, variability in the management of endometrial cancer across oncology centres is common and may have an impact on outcomes. There is limited literature on the current incidence of endometrial cancer, its detailed clinicopathological pattern, prognosis and practices in the management of endometrial cancer from Ghana. Lack of such information hampers the development of strategies to improve the outcome. Aim: To assess the treatment outcomes and factors affecting recurrence and survival in endometrial cancer patients treated with curative intent at the Korle Bu Teaching Hospital from January 2009 to December 2018. Methodology: In this retrospective study, data on patients with histological diagnosis of endometrial carcinoma seen at the National Radiotherapy, Oncology and Nuclear Medicine Centre treated between 1st January 2009 and 31st December 2018 were retrieved from the database. All patients had total abdominal hysterectomy with or without pelvic +/- para-aortic lymphadenectomy/sampling. Adjuvant therapy included external beam radiotherapy (EBRT) on cobalt- 60 machine +/-vaginal brachytherapy either with low or high dose rate +/- chemotherapy depending on risk stratification. Information regarding the demographic, clinical and pathological status of patients, type and sequence of treatment and follow-up of the patient after treatment was retrieved from the patients’ medical records. Patients that met the inclusion criteria were assessed. They were then categorized into risks groups based on the PORTEC definition and analyzed for the following endpoints: loco-regional and distant recurrence rates, the overall and disease–free survival rates, and factors affecting recurrence, disease-free and overall survival. Results: A total of 146 out of 269 patients were eligible for the study. The mean age was 61.3 years with majority being postmenopausal (77%) and a high prevalence of hypertension (42%) and diabetes (20%). The commonest presentation was abnormal vaginal bleeding (79%) and major histological type was endometrioid adenocarcinoma (78%). All patients had total abdominal hysterectomy with bilateral salpingo-oophrectomy with a lymph node dissection rate of 11% and a lymph node positivity rate of 62.5%. Less than half (47%) were FIGO stage 1. The 5year overall survival was 87.5%, 69%. 57% and 30% respectively for low, intermediate, high Intermediate and high risk patients (P-value: 0.001) whiles that for disease-free survival was 67%, 59%, 64.5% and 54% (P- value: 0.74). Adjuvant radiotherapy resulted in significantly improved 2year disease-free survival compared to those who had no radiotherapy in intermediate (100% vs 54% p-value: 0.006), high intermediate (87.5% vs 63%, p-value:0.041) and high risk (70.5% vs 45.5% p-value :0.041) but not overall survival. There was no difference in disease free and overall survival between patients who had pelvic lymphadenectomy and those who did not. After a median follow up of 34.5 months, there were 51 (35%) recurrences, majority of which were pelvic. Lymphovascular space invasion was the only factor associated with recurrence(p-value:0.01) whiles FIGO stage (P-value: 0.05), grade(p-value:0.03) and histology(p-calue:0.02) were associated with survival. Marital status was the only sociodemographic factor associated with survival Conclusion: Overall survival outcome for patients with endometrial cancer is comparable to developed countries but not disease-free survival which was poorer due to high recurrence rate. Adjuvant radiotherapy significantly improved the disease-free survival notably in intermediate risk population. Novel molecular testing is needed to better risk stratify and select patients who will benefit from adjuvant therapy to mitigate the high pelvic recurrences observed in the study.