Surveillance Strategies in Endometrial Cancer Care: Why Less Represents Progress

Prognostic significance of right subdiaphragmatic washing cytology in patients with endometrial cancer

Cancer cells in the right subdiaphragmatic lavage may reflect peritoneal dissemination, but its prognostic significance is unknown. This study investigated recurrence-free survival (RFS), overall survival (OS), and recurrence patterns in patients with curatively resected endometrial cancer by cytology collection site. Peritoneal cytology was collected at the beginning of surgery by washing the pelvic and right subdiaphragmatic cavity separately. The analysis included 465 patients with the median follow-up duration of 121 months. Of these, 62 (13%) patients had positive pelvic cytology and 22 (5%) patients had positive right subdiaphragmatic cytology. Patients positive for right subdiaphragmatic cytology were all positive for pelvic cytology, showing the worst RFS and OS among the study population. Multivariate analyses showed positive right subdiaphragmatic cytology, not pelvic cytology, significantly correlated with shorter RFS and OS when adjusted for clinicopathological factors. Patients with both pelvic and right subdiaphragmatic positive cytology had significantly higher peritoneal recurrence rates than those negative at both sites. However, patients with only positive pelvic cytology showed no significant difference in the recurrence rate. Our results suggest that the prognostic significance of peritoneal cytology may differ depending on the collection site in endometrial cancer and provide new insights to select patients for adjuvant therapy.

Impact of different follow-up regimens on health-related quality of life and costs in endometrial cancer patients: Results from the TOTEM randomized trial

PURPOSE

To investigate whether intensive follow-up (INT) after surgery for endometrial cancer impact health-related quality of life (HRQoL) and healthcare costs compared to minimalist follow-up (MIN), in the absence of evidence supporting any benefit on 5-year overall survival.

METHODS

In the TOTEM trial, HRQoL was assessed using the SF-12 and the Psychological General Well-Being (PGWB) questionnaires at baseline, after 6 and 12 months and then annually up to 5 years of follow-up. Costs were analyzed after 4 years of follow-up from a National Health Service perspective, stratified by risk level. The probability of missing data was analyzed for both endpoints.

RESULTS

1847 patients were included in the analyses. The probability of missing data was not influenced by the study arms (MIN vs INT OR: 0.97 95%CI: 0.87-1.08). Longitudinal changes in HRQoL scores did not differ between the two follow-up regimens (MIN vs INT SF-12 PCS: -0.573, CI95%: -1.31; 0.16; SF-12 MCS: -0.243, CI95%: -1.08; 0.59; PGWB: -0.057, CI95%: -0,88; 0,77). The mean cost difference between the intensive and minimalist arm was €531 for low-risk patients and €683 for high-risk patients.

CONCLUSION

In the follow-up of endometrial cancer after surgery, a minimalist treatment regimen did not affect quality of life and was cost-saving in both low-risk and high-risk recurrence patients. As previous results showed no survival benefit, a minimalist approach is justified. The relevant proportion of missing data on secondary outcomes of interest could be a critical point that deserves special attention.