IMR Press / EJGO / Volume 38 / Issue 3 / DOI: 10.12892/ejgo3621.2017

European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.

Open Access Original Research
Clinical outcomes and the role of adjuvant therapy sequencing in Type II uterine cancer following definitive surgical treatment
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1 Emory University School of Medicine, Atlanta, GA, USA
2 Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
3 Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
4 Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
5 Emory University, USA
6 Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
7 Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
Eur. J. Gynaecol. Oncol. 2017, 38(3), 404–412; https://doi.org/10.12892/ejgo3621.2017
Published: 10 June 2017
Abstract

Purpose of Investigation: Because of rarity, consensus on adjuvant therapies for Type II endometrial cancers (EC) remains undefined. Reporting their institutional outcomes, the present authors assessed the impact of adjuvant therapies on recurrence and overall survival in women with 2009 FIGO Stage I-III Type II EC. Material and Methods: The authors identified 108 women, treated with definitive surgery between 2000-2013, with pathologically-confirmed Type II EC (non-endometrioid [NEM, n=80] and high grade endometrioid [G3EEC, n=28]) Cox proportional hazard models were used to assess the effect of prognostic variables on disease-free (DFS) and overall survival (OS). Kaplan-Meier method was used to assess survival. Results: Of the 108 women, 83 (77%) were African American (AA). Fifty-nine (55%), 12 (11%), and 37 (34%) were Stage I, II, and III, respectively. Ninety-seven patients received adjuvant therapy: 52 (radiation only), four (chemotherapy only), and 40 (combined). During follow-up (median 41 months), 44 patients (41%) recurred. Five-year DFS was 53% overall (48% [NEM], 80% [G3EEC]). Five-year OS was 75% overall (68% [NEM], 95% [G3EEC]). On multivariate analysis, lower stage and adjuvant radiation improved DFS. Higher stage, NEM, and increasing age were poor prognostic indicators of OS. Conclusion: Representing a large single institutional cohort for Type II EC, the present study’s observed survival rates are consistent with previous studies, despite the relatively high frequency of carcinosarcoma and Stage III/nodal disease. The protective effect on recurrence was not lost when radiation was delayed for chemotherapy. The present results support a multimodal adjuvant approach for treating all stages of invasive NEM EC.
Keywords
Endometrial neoplasms
Surgical pathology
Chemotherapy
Adjuvant
Radiotherapy
Adjuvant
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