To identify the risk factors for recurrence of endometrial cancer (EC) and the prognostic factors for endocrine therapy after recurrence.

Eighty-three EC patients who relapsed after completing initial treatment in our hospital from January 2021 to December 2024 were selected as an observation group. After receiving endocrine therapy, they were divided into a good prognosis subgroup and a poor prognosis subgroup based on follow-up results. Another 332 patients who completed initial treatment during the same period, underwent regular follow-up within the study time range, and did not relapse were selected as a control group. Various indicators were compared between the observation group and the control group, as well as between different subgroups. Univariate and Logistic multivariate regression analyses were performed to screen for the main factors affecting disease recurrence and prognosis.

Among the 83 patients, 51 had a good prognosis (61.45%, 51/83) and 32 had a poor prognosis (38.55%, 32/83). Logistic regression analysis showed that age≥55 years old (odds ratio [OR]=2.298), menopause (OR=2.482), FIGO stage Ⅱ (OR=2.067), tumor diameter≥2 cm (OR=2.094), muscle infiltration depth≥1/2 (OR=1.818), pelvic lymph node positivity (OR=2.392), ER negativity (OR=2.776), PR negativity (OR=3.963), and Ki67 positivity rate≥50% (OR=2.529) were high-risk factors for EC recurrence (P＜0.05). Meanwhile, age at recurrence (OR=6.209), progression-free survival (PFS)＜12 months after initial treatment (OR=16.007), extrapelvic recurrence (OR=3.943), Bokhman classification type Ⅱ (OR=2.252), recurrent ER positivity (OR=3.536), recurrent PR positivity (OR=2.768), and NSMP subtype (OR=3.747) were identified to be independent risk factors affecting the prognosis of endocrine therapy after recurrence (P＜0.05).

The recurrence rate of EC is high, particularly in patients with high-risk pathological features-including advanced age, postmenopausal status at onset, high pathological grade, tumor size ≥2 cm, deep myometrial invasion, lymphovascular space invasion, and positive pelvic lymph nodes-as well as unfavorable molecular markers such as ER negativity, PR negativity, and strong Ki67 positivity. Endocrine therapy is an effective method for recurrent EC, but the prognosis of patients is affected by age, PFS after initial treatment, recurrence site, Bokhman classification, molecular classification, ER and PR expression, and other factors, which should be given special attention.