Long-term prognostic value of robot-assisted laparoscopic staging for endometrial cancer

Abstract

Introduction Endometrial cancer is a common malignancy in women and its incidence is increasing. Patients with high-intermediate risk or high-risk endometrial cancer undergo staging surgery to further determine adjuvant therapy. Patients who are upstaged to higher FIGO stages following surgery are expected to have a poorer prognosis, although it is unclear whether surgery and adjuvant treatments improve survival rates. Materials & Methods A retrospective cohort study was conducted using a database of women diagnosed with early stage, high-intermediate or high-risk endometrial cancer scheduled for robot-assisted laparoscopic staging between 2008 and 2023. Survival rates were analysed using the Kaplan-Meier method. Subgroup analyses were performed for histological subtypes. Results A total of 166 patients were included. 32 patients (19.3%) were upstaged postoperatively to FIGO stage III-IV. Upstaged patients exhibited significantly lower overall, disease-specific, and disease-free survival. Patients with serous or clear cell carcinoma who were postoperatively upstaged exhibited significantly lower overall, disease-specific, and disease-free survival. Patients with endometrioid carcinoma who were postoperatively upstaged did not exhibit significantly lower overall or disease-specific survival, though disease-free survival was significantly reduced. In 52 patients (31.3%) recurrence of disease occurred. Discussion This study highlights the critical role of accurate staging in predicting survival outcomes, especially in patients with serous or clear cell carcinoma. A possible hypothesis for the comparable survival between the patients with EEC who were upstaged postoperatively and those who were not could be that adjuvant therapy is more effective in these patients. Applying the new molecular classification may allow better prediction of prognosis and improve adjuvant therapy strategies.