The impact of multimodality treatment on outcomes of patients with type II endometrial carcinoma: A single institution experience.

Abstract

e16552 Background: To determine the impact of different adjuvant treatment modalities on relapse-free (RFS), disease-specific (DSS) and overall survival (OS) of patients with type II endometrial carcinoma after hysterectomy. Methods: Our prospectively-maintained database of 1605 uterine cancer patients was reviewed for this IRB-approved study. We identified 167 consecutive patients with type II endometrial carcinoma 2009 FIGO stages IA-IIIC2 who underwent hysterectomy between 1991-2012. Recurrence-free survival (RFS), DSS and OS was calculated from the date of hysterectomy using the Kaplan Meier method. Cox regression modeling was used to explore the risks of various factors on recurrence. Results: Median follow-up was 5.4 years. Median age was 65 years. All patients underwent hysterectomy and salpingo-oophorectomy. 95% had peritoneal cytology and 87% underwent lymphadenectomy. 61% were stage I, 11% with stage II and 28% with stage III (including 33 patients with lymph node involvement). There were 60% of patients with uterine serous carcinoma, 22% with clear cell and 18% with a mixed histology. 29% of patients received adjuvant chemoradiotherapy, 25% received either chemotherapy or radiothereapy alone and 21% were managed with close surveillance. 5-year OS, DSS and RFS was 54%, 64% and 54%, respectively. On multivariate analysis and after adjusting for other prognostic factors, multimodality treatment, (p = 0.0076) presence of LVSI (p = 0.0443), lower uterine segment involvement (p = 0.0003) and involvement of lymph nodes (p = 0.001) were the only independent predictors of RFS. These factors in addition to positive peritoneal cytology were also significant predictors of DSS. Age at diagnosis, the presence of LVSI, positive lymph nodes, positive peritoneal cytology and adjuvant multimodality treatment were the only predictors of OS with p = 0.0251, 0.0178, 0.003, 0.0019 and 0.046, respectively. Conclusions: In this hospital-based study, adjuvant radiation treatment combined with chemotherapy was independent predictor of RFS, DSS and OS compared to single modality treatment. These findings need validation from a prospective randomized study.