With the increasing prevalence among Americans of risk factors like physical inactivity and overweight, the incidence of endometrial cancer (EC) continues to rise, according to a study published in BMC Cancer. Although most ECs can be diagnosed at an early stage and have a 5-year survival rate of more than 90%, recurrence and final mortality occur in approximately 20% of patients with endometrioid carcinoma (type I) and 50% with non-endometrioid carcinoma (type II). “Women with recurrent or metastatic diseases have 5-year survival rates as low as 17–55%,” the study authors wrote. “Unfortunately, in the past decade, little progress has been made in improving the survival rate of EC. Therefore, early identification of risk factors for recurrence is an important challenge to improve the prognosis of patients with EC.”
Based on this information, the study team sought to identify predictive value of apparent diffusion coefficient (ADC) values and MRI-based radiomics for all recurrences in 174 patients with EC, 162 and 12 of whom underwent laparoscopic surgery or open laparotomy, respectively. Among total patients, 48 received postoperative radiotherapy and 105 received adjuvant or concurrent chemotherapy.
15% Tumor Recurrence
The median follow-up for all patients was 31 months (range, 4–69 months), and the median follow-up time for the recurrent cohort was 18 months (range, 4–50 months). Baseline clinicopathological features and mean ADC (ADCmean), minimum ADC (ADCmin), and maximum ADC (ADCmax) were analyzed. Radiomic parameters were extracted on T2 weighted images and screened by logistic regression, and then a radiomics signature was developed to calculate the radiomic score (radscore). Kaplan–Meier analysis was conducted, and a Cox regression model was used to evaluate the correlation between clinicopathological features, ADC values, and radscore with recurrence, and verified in the test group.
The researchers observed tumor recurrence in 27 patients (15.5%). Three (11.1%) isolated pelvis recurrences, one (3.7%) isolated vaginal recurrence, six (22.2%) isolated abdominal failures, six (22.2%) combined pelvic and distant failures, and 11 (40.8%) distant failures occurred. The 3-year and 5-year disease-free survival (DFS) rates for the entire cohort were 91.2% (95% CI, 86.9–95.5%) and 75.2% (95% CI, 64.8–85.6%), respectively.
Early Risk Factor Identification Is Key
ADCmean showed an inverse correlation with recurrence, while radscore was positively associated with recurrence. In univariate analyses, FIGO stage, pathological types, myometrial invasion, ADCmean, ADCmin, and radscore were associated with recurrence. Multivariate Cox analysis showed that pathological types, ADCmean, and radscore were independent risk factors for recurrence, which were verified in the test group.
“Patients with EC are at certain risk of recurrence, and early identification of risk factors for recurrence and enhanced treatment intensity are significant to improve prognosis,” the authors wrote. “Therefore, it is necessary to develop an early, comprehensive and non-invasive evaluation method to assess the possible adverse prognosis of EC. MRI is an important tool to preliminarily assess the extent of EC lesions. The ADC of diffusion-weighted imaging can reflect the malignancy of the tumor, which has proven to be valuable in the diagnosis, typing, and grade of EC. ADCmean values and MRI-derived radiomics may provide additional prognostic information in addition to traditional prognostic factors.”