Abstract

BACKGROUND: Tumor perfusion is significantly associated with the development and aggressiveness of endometrial cancer. The aim of this study was to assess the prognostic value of quantitative perfusion parameters measured by contrast-enhanced ultrasonography (CEUS) in endometrial cancer before surgery.

MATERIAL AND METHODS: A total of 223 patients with endometrial cancer were included between 1 May 1 2013 and 1 May 1 2017 for preoperative CEUS. The mean enhancement rate (ER) was calculated as enhancement intensity (EI)/rise time (RT) results from time‑intensity curve (TIC) during CEUS. After a mean follow-up of 33.5±9.9 months, the correlation of ER and postoperative overall survival (OS) and disease-free survival (DFS) was analyzed using univariate and multivariate analysis.

RESULTS: The optimal cutoff ER value predicting survival based on the ROC curve was 1.8 dB/s. Kaplan-Meier univariate analysis demonstrated that a patient with a high ER level had worse DFS and OS than those with a low ER (DFS, P<0.01; OS, P<0.05). In multivariate analysis, ER was confirmed as an independent predictor for both recurrence (HR, 1.68; 95% CI: 1.01–7.73) and OS (HR, 1.98; 95%CI: 1.01–7.83) for patients with endometrial cancer (both P<0.05).

CONCLUSIONS: Perfusion variables measured by CEUS are significantly useful predictive factor for postoperative survival in endometrial cancer.

Keywords: Endometrial Neoplasms, Hemoperfusion, Prognosis, Ultrasonography, Aged, Disease-Free Survival, Kaplan-Meier Estimate, Middle Aged, perfusion imaging, Retrospective Studies, Survival, Survival Rate