Survival Outcomes and the Role of Adjuvant Therapy Sequencing in Type II Uterine Cancer After Definitive Surgery

Abstract

between LVI status. Logistic regression examined the effect of covariates on LVI status. Kaplan Meier and Cox regression analysis were performed to examine the relationship between LVI and time to recurrence. Results: Average age was 70.1 (SDy 9.5) years; 117 (84.2%) had endometrial adenocarcinoma and 22 had uterine carcinosarcoma. Stage distribution and % of LVI in each stage category are listed in Table 1. Of the 68 (48.9%) women with LVI, 21 had pelvic LNM, 10 had paraaortic LNM, and 7 had both pelvic and paraaortic LNM.Womenwith LVI had 13 timesmore risk of pelvic LNM and 5.6 times the risk of paraaortic LNM. Logistic regression revealed tumor size (ORZ 1.3 pZ 0.02), tumor type, pelvic LNM (ORZ 2.6, p Z <0.01), and paraaortic LNM (OR Z 5.7, p Z 0.03) to be significantly associated with LVI. Adjusting for age and tumor size, only pelvic LNM (ORZ 6.0, pZ 0.04) and paraaortic LNM had elevated risk (ORZ 2.1, p Z 0.59) for LVI. 42 women had evidence of recurrence: 1 local, 1 regional, 7 regional and distant, 31 distant and 2 unspecified. The probability of no recurrence at 12, 24, 36 and 60monthswith andwithout LVI are 77, 66, 58, 51 and 97, 95, 89 and85 percent respectively (log-rank p valueZ<0.01). Cox regression analysis showed that presence of LVI had 3.9 times more hazard of recurrence compared to those without. Conclusions: LVI is an important pathologic prognostic factor that should be taken into account when deciding on adjuvant therapy. As noted above, the incidence of LNM with LVI is higher, and time to recurrence is shorter. Women with LVI may need additional adjuvant therapy or closer interval follow-up.