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Adjuvant treatment and outcomes for patients with stage IIIA grade 1 endometrioid endometrial cancer.

Publication ,  Journal Article
Montes de Oca, MK; Albright, BB; Secord, AA; Havrilesky, LJ; Moss, HA
Published in: Int J Gynecol Cancer
December 2021

OBJECTIVE: The role and type of adjuvant therapy for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIA grade 1 endometrioid endometrial adenocarcinoma are controversial. This retrospective cohort study aimed to determine associations between adjuvant therapy use and survival among patients with stage IIIA grade 1 endometrial cancer. METHODS: Patients who underwent primary surgery for stage IIIA (FIGO 2009 staging) grade 1 endometrial cancer between January 2004 and December 2016 were identified in the National Cancer Database. Demographics and receipt of adjuvant therapy were compared. Overall survival was analyzed using Kaplan-Meier curves, log-rank test, and multivariable Cox proportional hazard models. RESULTS: Of 1120 patients, 248 (22.1%) received no adjuvant treatment, 286 (25.5%) received chemotherapy alone, 201 (18.0%) radiation alone, and 385 (34.4%) chemotherapy and radiation. Five-year overall survival rate was 83.0% (95% CI 80.1% to 85.6%). Older age, increasing comorbidity count, and lymphovascular space invasion status were significant negative predictors of survival. Over time, there was an increasing rate of chemotherapy (45.4% in 2004-2009 vs 69.2% in 2010-2016; p<0.001). In the multivariable analysis, chemotherapy was associated with significantly improved overall survival compared with no adjuvant therapy (HR 0.49 (95% CI 0.31 to 0.79); p=0.003). There was no survival association when comparing radiation alone with no treatment, and none when adding radiation to chemotherapy compared with chemotherapy alone. Those with lymphovascular space invasion (n=124/507) had improved overall survival with chemotherapy and radiation (5-year overall survival 91.2% vs 76.7% for chemotherapy alone and 27.3% for radiation alone, log-rank p<0.001), but there was no survival difference after adjusting for age and comorbidity (HR 0.25 (95% CI 0.05 to 1.41); p=0.12). CONCLUSIONS: The use of adjuvant chemotherapy for the treatment of stage IIIA grade 1 endometrial cancer increased over time and was associated with improved overall survival compared with radiation alone or chemoradiation. Patients with lymphovascular space invasion may benefit from combination therapy.

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Published In

Int J Gynecol Cancer

DOI

EISSN

1525-1438

Publication Date

December 2021

Volume

31

Issue

12

Start / End Page

1549 / 1556

Location

England

Related Subject Headings

  • Retrospective Studies
  • Radiotherapy, Adjuvant
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Lymph Node Excision
  • Kaplan-Meier Estimate
  • Humans
  • Female
 

Citation

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Montes de Oca, M. K., Albright, B. B., Secord, A. A., Havrilesky, L. J., & Moss, H. A. (2021). Adjuvant treatment and outcomes for patients with stage IIIA grade 1 endometrioid endometrial cancer. Int J Gynecol Cancer, 31(12), 1549–1556. https://doi.org/10.1136/ijgc-2021-002884
Montes de Oca, Mary Katherine, Benjamin B. Albright, Angeles Alvarez Secord, Laura J. Havrilesky, and Haley A. Moss. “Adjuvant treatment and outcomes for patients with stage IIIA grade 1 endometrioid endometrial cancer.Int J Gynecol Cancer 31, no. 12 (December 2021): 1549–56. https://doi.org/10.1136/ijgc-2021-002884.
Montes de Oca MK, Albright BB, Secord AA, Havrilesky LJ, Moss HA. Adjuvant treatment and outcomes for patients with stage IIIA grade 1 endometrioid endometrial cancer. Int J Gynecol Cancer. 2021 Dec;31(12):1549–56.
Montes de Oca, Mary Katherine, et al. “Adjuvant treatment and outcomes for patients with stage IIIA grade 1 endometrioid endometrial cancer.Int J Gynecol Cancer, vol. 31, no. 12, Dec. 2021, pp. 1549–56. Pubmed, doi:10.1136/ijgc-2021-002884.
Montes de Oca MK, Albright BB, Secord AA, Havrilesky LJ, Moss HA. Adjuvant treatment and outcomes for patients with stage IIIA grade 1 endometrioid endometrial cancer. Int J Gynecol Cancer. 2021 Dec;31(12):1549–1556.
Journal cover image

Published In

Int J Gynecol Cancer

DOI

EISSN

1525-1438

Publication Date

December 2021

Volume

31

Issue

12

Start / End Page

1549 / 1556

Location

England

Related Subject Headings

  • Retrospective Studies
  • Radiotherapy, Adjuvant
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Lymph Node Excision
  • Kaplan-Meier Estimate
  • Humans
  • Female