Adjuvant treatment for patients with stage IIIB endometrioid endometrial cancer following hysterectomy

Abstract

Objectives: Given its rarity, the optimal management of patients with endometrial cancer extending to the parametria, vagina or pelvic sidewall in the absence of lymph node metastasis is not well defined. We aimed to investigate the outcomes of patients with stage IIIB endometrioid cancer following hysterectomy based on different adjuvant treatment strategies. Methods: Patients with no history of another tumor diagnosed between 2004 and 2015 with stage IIIB endometrioid adenocarcinoma of the uterus who underwent primary hysterectomy, had negative lymph nodes and at least one month of follow-up were selected from the National Cancer Database. Overall survival between patients who were observed or received chemotherapy-only (CT), radiotherapy-only (RT) and chemoradiation (CRT) were compared with the log-rank test after generation of Kaplan-Meier curves. A Cox multivariate model was constructed to control for confounders. Results: A total of 717 patients with a median age of 64 years who met the inclusion criteria were identified. Radical hysterectomy was performed for 17% of cases. Data on margin status was available for 638 cases; 73.5% had negative margins. Tumor was extending to the parametria for 239 (33.3%) patients, to the vagina for 235 (32.8%) cases, to the pelvic sidewall for 102 (14.2%) cases, and was abutting bladder/colon (without invasion) for 55 cases (7.7%) while 86 patients (12%) had stage IIIB not otherwise specified. A total of 147 (20.5%) patients did not receive adjuvant treatment, while 118 (16.5%) received chemotherapy-alone, 206 (28.7%) received radiotherapy-alone and 246 (34.3%) received chemoradiation. Tumor grade and presence of comorbidities was comparable between the groups. Five-year OS rates for patients who did not receive adjuvant treatment was 49.8% compared to 56% for those who had chemotherapy-alone, 60% for those who had radiotherapy-alone and 76.2% for those who received chemoradiation, p<0.001. After controlling for patient age, race, presence of comorbidities, insurance status, tumor grade, and margin status, compared to observation alone, patients who received chemoradiation (HR: 0.36, 95% CI: 0.25, 0.52) and radiation-alone (HR: 0.64, 95% CI: 0.46, 0.89) but not chemotherapy-alone (HR: 0.81, 95% CI: 0.59, 1.27) had better survival. Compared to radiation-alone, chemoradiation was associated with better survival (HR: 0.56, 95% CI: 0.39, 0.81). Conclusions: Chemoradiation is associated with better survival outcomes for patients with stage IIIB endometrial cancer Given its rarity, the optimal management of patients with endometrial cancer extending to the parametria, vagina or pelvic sidewall in the absence of lymph node metastasis is not well defined. We aimed to investigate the outcomes of patients with stage IIIB endometrioid cancer following hysterectomy based on different adjuvant treatment strategies. Patients with no history of another tumor diagnosed between 2004 and 2015 with stage IIIB endometrioid adenocarcinoma of the uterus who underwent primary hysterectomy, had negative lymph nodes and at least one month of follow-up were selected from the National Cancer Database. Overall survival between patients who were observed or received chemotherapy-only (CT), radiotherapy-only (RT) and chemoradiation (CRT) were compared with the log-rank test after generation of Kaplan-Meier curves. A Cox multivariate model was constructed to control for confounders. A total of 717 patients with a median age of 64 years who met the inclusion criteria were identified. Radical hysterectomy was performed for 17% of cases. Data on margin status was available for 638 cases; 73.5% had negative margins. Tumor was extending to the parametria for 239 (33.3%) patients, to the vagina for 235 (32.8%) cases, to the pelvic sidewall for 102 (14.2%) cases, and was abutting bladder/colon (without invasion) for 55 cases (7.7%) while 86 patients (12%) had stage IIIB not otherwise specified. A total of 147 (20.5%) patients did not receive adjuvant treatment, while 118 (16.5%) received chemotherapy-alone, 206 (28.7%) received radiotherapy-alone and 246 (34.3%) received chemoradiation. Tumor grade and presence of comorbidities was comparable between the groups. Five-year OS rates for patients who did not receive adjuvant treatment was 49.8% compared to 56% for those who had chemotherapy-alone, 60% for those who had radiotherapy-alone and 76.2% for those who received chemoradiation, p<0.001. After controlling for patient age, race, presence of comorbidities, insurance status, tumor grade, and margin status, compared to observation alone, patients who received chemoradiation (HR: 0.36, 95% CI: 0.25, 0.52) and radiation-alone (HR: 0.64, 95% CI: 0.46, 0.89) but not chemotherapy-alone (HR: 0.81, 95% CI: 0.59, 1.27) had better survival. Compared to radiation-alone, chemoradiation was associated with better survival (HR: 0.56, 95% CI: 0.39, 0.81). Chemoradiation is associated with better survival outcomes for patients with stage IIIB endometrial cancer