The Impact of Different Adjuvant Managements on Survival Endpoints in Women with Adequate Surgical Staging Early Stage Uterine Serous Carcinoma

Abstract

Non-endometrioid carcinomas, which includes uterine serous carcinoma (USC), comprise only 15% of all endometrial carcinomas but cause about 40% of deaths in this patient population. The ideal adjuvant management of patients with early-stage USC is remains unknown. To report survival outcomes in women with early stage USC after adequate surgical staging with various adjuvant management options. After IRB study approval, our prospectively-maintained database for women with endometrial carcinoma was queried for women with 2009 International Federation of Gynecology and Obstetrics (FIGO) stages I-II USC based on WHO pathologic definition who underwent adequate surgical staging between 1/1991 and 4/2017 followed by adjuvant management [surveillance, radiation treatment (RT) or chemotherapy (CT) or combination (CRT)]. Chi-squared tests were performed to compare differences in outcome by type of adjuvant management. Recurrence-free (RFS), disease-specific (DSS) and overall survival (OS) were assessed by Kaplan-Meier and log-rank tests. Univariate and multivariate analyses were performed to identify statistically significant predictors of survival endpoints. We identified 155 women who met our inclusion criteria. The median follow-up time was 54.8 months. 75% of the study cohort were with stage IA, 14% stage IB and 11% with stage II. All women underwent pelvic lymph node dissection with a median number of dissected lymph nodes of 15. Omentectomy was performed in 62% of women. Adjuvant RT was utilized in 55% of women (54 with vaginal brachytherapy alone, 22 with pelvic RT and 10 with combination). Most commonly used chemotherapy was carboplatin and paclitaxel with a median number of cycles of 6 5-year RFS was 78% for those received CRT, 84% for RT alone, 65% who received CT alone and 48% for those who were observed (p=0.03). 5-year DSS was 79%, 92%, 66% and 53%, respectively (p=0.02). 5-year OS was 76%, 79%, 63% and 53%, respectively (p=0.21). On multivariate analysis of OS, old age, and not receiving any adjuvant therapies were independent predictors of worse OS. Independent predictors of better RFS and DSS included adjuvant RT alone or with chemotherapy, and lack of lymphovascular space invasion. In this cohort of women with adequate surgical staging, adjuvant radiation treatment with or without chemotherapy is associated with reduced tumor recurrence with improved survival endpoints.