Less-favourable prognosis for low-risk endometrial cancer patients with a discordant pre-versus post-operative risk stratification

F. A. Eggink, C. H. Mom, K. Bouwman, D. Boll, J. H. Becker, C. L. Creutzberg, G. C. Niemeijer, W. J. van Driel, A. K. Reyners, A. G. van der Zee, G. L. Bremer, N. P. Ezendam, R. F. Kruitwagen, J. M. Pijnenborg, H. Hollema, H. W. Nijman*, M. A. van der Aa

*Corresponding author for this work

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Background: Pre-operative risk stratification based on endometrial sampling determines the extent of surgery for endometrial cancer (EC). We investigated the concordance of pre- and post-operative risk stratifications and the impact of discordance on survival.

Methods: Patients diagnosed with EC within the first 6 months of the years 2005-2014 were selected from the Netherlands Cancer Registry (N = 7875). Pre-and post-operative risk stratifications were determined based on grade and/or histological subtype for 3784 eligible patients.

Results: A discordant risk stratification was found in 10% of patients: 4% (N = 155) had high pre-and low post-operative risk and 6% (N = 215) had low pre-and high post-operative risk. Overall survival of patients with high pre-and low post-operative risk was less favourable compared to those with a concordant low risk (80% versus 89%, p = 0.002). This difference remained significant when correcting for age, stage, surgical staging and adjuvant therapy (hazard ratio 1.80, 95% confidence interval 1.28-2.53, p = 0.001). Survival of patients with low pre-and high post-operative risk did not differ from those with a concordant high risk (64% versus 62%, p = 0.295).

Conclusion: Patients with high pre-and low post-operative risk have a less favourable prognosis compared to patients with a concordant low risk. Pre-operative risk stratifications contain independent prognostic information and should be incorporated into clinical decision-making. (C) 2017 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)82-90
Number of pages9
JournalEuropean Journal of Cancer
Publication statusPublished - Jun 2017


  • Endometrial cancer
  • Risk stratification
  • Histology
  • Clinical decision-making
  • Overall survival


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