Recurrence free survival and overall survival in women with stage 1A uterine serous carcinoma

Abstract

Objectives: National Comprehensive Cancer Network Treatment guidelines for stage 1A uterine serous carcinoma (USC) outline four options for adjuvant management: systemic therapy + vaginal brachytherapy, external beam radiotherapy ± vaginal brachytherapy, vaginal brachytherapy in select cases of non-invasive disease, or observation. We evaluated the patterns of recurrence free survival (RFS), and overall survival (OS) in women with stage 1A USC based on the type of adjuvant therapy. Methods: After IRB approval, we identified all women with stage 1A USC between January 2011 and September 2019 treated at our institution. Demographics and outcome measures were abstracted from the medical records. Cox proportional hazard models, log-rank tests, and comparisons of means were used to calculate significance (p Results: Sixty-three patients were eligible. Median age at diagnosis was 67 years (range 54-86). Median body mass index (BMI) was 30.6 (range 18.6-47.3). The majority (68%) underwent MIS staging. Nineteen (30%) patients did not have adjuvant therapy, 13 (21%) had adjuvant chemotherapy (CT) only, 3 (5%) had adjuvant radiotherapy (RT) only (100% had vaginal brachytherapy). 28 patients (44%) had chemotherapy and radiotherapy (CT+RT). The mean overall survival (OS) was 60.8 months (range 1-105 months). Thirteen (21%) patients had recurrent disease. Mean RFS was 35.1 months (range: 3-82). Highest rate of recurrence in the RT only (33%). Five (38%) patients had vaginal cuff or pelvic recurrence, 3 (23%) in abdomen and pelvis, 3 (23%) in the abdomen only, and 2 (15%) in the lungs. Eleven (17.4%) patients had positive peritoneal cytology. Eight (73%) had adjuvant therapy with CT±RT. Six (55%) patients with positive cytology had disease recurrence. Mean RFS and OS for patients with positive cytology was 40.3 and 48.7 months, respectively. Positive cytology showed a 5.18-fold increase in developing recurrence compared to those with negative cytology (p=0.015). This was independent of age, race, smoking status, BMI, surgical approach, tumor size, and adjuvant therapyThere was no significant difference between the observation and any and all the adjuvant therapy groups with respect to OS (p=0.62) and RFS (p=0.95). There was no significant difference in OS and RFS between CT only and CT+RT groups (p>0.05). A significant difference in RFS occurred in patients with positive cytology (p=0.002) but there was no difference in OS. Download : Download high-res image (84KB) Download : Download full-size image Conclusions: Our data suggest that there is no difference in RFS and OS between observation versus any form of adjuvant therapy. There was a higher rate of recurrence in patients with positive pelvic cytology. Use of peritoneal cytology in the staging of high-grade uterine cancers may be important in deciding optimal adjuvant therapy for stage 1A USC. Multi-institutional randomized controlled trials are needed to determine the optimal treatment for early stage USC.