Identifying high-risk groups for recurrence in endometrial cancer: The role of ESMO–ESGO–ESTRO risk classification

OBJECTIVE: This study aimed to identify prognostic factors associated with recurrence in patients with stages I-III endometrial cancer who underwent surgical treatment. METHODS: The data of all patients who were followed in our clinic 2010-2024 after surgery for endometrial cancer were analyzed retrospectively. Patients were classified into four groups-low, intermediate, high-intermediate, and high risk-according to the 2016 ESMO-ESGO-ESTRO consensus risk classification system. RESULTS: A total of 200 patients were included in the study. The median follow-up duration for the cohort was 39 months (range: 7-180), and recurrence was observed in 26 patients (13%). The endometrioid subtype was present in 175 patients (87.5%). According to the ESMO-ESGO-ESTRO risk classification, 79 patients (39.5%) were in the low-risk group, while 49 patients (24.5%) were classified as high risk. Age over 65 years (P < 0.001), a high ECOG performance score (P < 0.001), non-endometrioid histology (P < 0.001), ≥50% myometrial invasion (P = 0.002), presence of lymphovascular space invasion (P < 0.001), high tumor grade (P < 0.001), abnormal p53 status (P = 0.002), increased tumor diameter (P < 0.001), and high ESMO-ESGO-ESTRO risk category (P < 0.001) were significantly associated with recurrence. In multivariate analysis, high ECOG performance score (P = 0.002) and high ESMO-ESGO-ESTRO risk group (P = 0.011) were identified as independent predictive factors. CONCLUSION: ECOG performance status is an accessible, low-cost clinical parameter that can be effectively integrated with the ESMO-ESGO-ESTRO risk classification to guide treatment decisions and identify high-risk patients for closer follow-up. In settings where molecular classification is not feasible, the 2016 risk stratification remains a reliable tool for therapeutic planning.