Delayed time to surgery with hormonal treatment does not adversely impact outcomes in women with low-grade endometrioid endometrial cancer

Abstract

<h3>Objectives:</h3> Longer wait times from diagnosis of low grade endometrioid endometrial cancer to treatment is associated with decreased overall survival. LNG-IUD therapy or systemic progesterone therapy can be reasonable options for conservative management of early-grade, uterus confined endometrial cancer in patients who wish to delay definitive surgical management. We sought to determine if delaying surgical treatment with progestin therapy adversely affected grade and stage of cancer at time of surgery. <h3>Methods:</h3> The Tumor Registries at a county and university hospital were used to perform a retrospective chart review of patients diagnosed with endometrial cancer from 2009 to 2017. Those with grade 1 or grade 2 endometrioid endometrial adenocarcinoma on EMB or D&C were included. Exclusion criteria included cervical involvement, imaging suggestive of metastatic disease, or completed surgical treatment prior to presentation for care. Patients were grouped into four cohorts: surgery within 42 days of diagnosis (S, n=65), surgery after 42 days (DS, n=52), delayed surgery after progestin therapy (DS+H, n=20), and progestin therapy alone (H, n=21). A one-way ANOVA test and two-tailed t-test were performed to determine whether cohorts differed demographically or in regard to grades and stages. <h3>Results:</h3> 158 patients met inclusion criteria. In total, average age at diagnosis was 55.30 years, average BMI was 39.22, and average Charlton Comorbidity Index (CCI) was 3.97. There was a difference in average age between the S v DS+H (p=0.002, 58.4 v 46.8) and DS v DS+H (p=0.009, 56.6 vs 46.8) cohorts. There was a difference in average BMI between the S vs DS+H (p=0.005, 35.9 vs 42.7) and S v H (p=0.01, 35.9 vs 46.4) cohorts. There were no differences in CCI scores between groups (p=0.25) (Figure 1). There were no differences between the cohorts in regard to initial grade (p=0.36), grade at surgery (p=0.75), grade change between initial diagnosis and surgical specimen (p=0.47), or surgical stage (p=0.52). <h3>Conclusions:</h3> Delayed time to surgery with progestin treatment does not result in stage progression or change in grade. Patients treated with hormones tended to be younger and with higher BMIs. Temporary progestin therapy should be considered if delaying surgical treatment for women with corpus confined low grade endometrioid endometrial cancer.