Abstract
Objective: Although endometrial cancer (EC) is a hormone dependent neoplasm, there are no recommendations for the determination of steroid hormone receptors in the tumor tissue and no hormone therapy has ever been assessed in the adjuvant setting. The purpose of this study was to explore the effect of adjuvant aromatase inhibitors (AIs) on progression-free survival (PFS) and overall survival (OS) in patients with early stage and steroid receptors-positive EC. Methods: We retrospectively analyzed clinical and pathological factors in 73 patients with high-risk (49.3%) or low-risk (50.7%) stage I (n = 71) or II (n = 2) endometrial cancer who received by their preference after counseling either no treatment (reference group) or AI. Prognostic factors were well balanced between groups. Expression of estrogen receptor (ER), progesterone receptor (PgR), and Ki-67 index was correlated with clinical outcomes. Results: Univariate and multivariate Cox proportional regression analyses, adjusted for age, grade, stage, depth of myometrial invasion, lymphovascular space invasion, BMI, ER, PgR and Ki-67 labeling index levels, showed that PFS and OS had a trend to be longer in patients receiving AI than in the reference group HR= 0.23 (95% CI; 0.04–1.27) for PFS and HR= 0.11 (95% CI; 0.01–1.36) for OS. Conclusion: Compared with no treatment, AI exhibited a trend toward a benefit on PFS and OS in patients with early stage hormone receptor-positive EC. Given the exploratory nature of our study, randomized clinical trials for ER/PgR positive EC patients are warranted to assess the clinical benefit of AI and the potential predictive role of steroid receptors and Ki-67.
Highlights
Endometrial cancer (EC) is the most common cancer of the female reproductive organs affecting mainly postmenopausal women with an average age at diagnosis of 60 years
Hormone therapy could represent a tolerable and effective therapeutic option in the adjuvant setting but the lack of RCTs for evaluating its efficacy does not allow clarifying the clinical benefit in terms of progression-free survival (PFS) and overall survival (OS)
It is well known that estrogen is the most significant risk factor for type I EC and the results of genome analysis confirmed the association of high ER/PgR expression levels with endometrioid histology suggesting a prognostic role of steroid receptors
Summary
Endometrial cancer (EC) is the most common cancer of the female reproductive organs affecting mainly postmenopausal women with an average age at diagnosis of 60 years. The National Comprehensive Cancer Network (NCCN) has updated the guidelines for EC management including the use of hormone therapy for advanced low-grade endometrioid histology, preferably in patients with small tumor volume or an indolent growth pace, recommendations are category 2A because of the lack of definitive trials [13]. This retrospective cohort study aimed to probe the effect of AI in the adjuvant setting of EC and to explore the prognostic/predictive significance of ER/PgR expression and Ki-67 levels
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