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Impact of adjuvant treatment on outcome in high-risk early-stage endometrial cancer: a retrospective three-center study
  1. Limor Helpman1,2,3,
  2. Tamar Perri1,3,
  3. Natalie Lavee1,
  4. Nasreen Hag-Yahia2,
  5. Hila Amichay Chariski1,
  6. Sarit Kalfon1,
  7. Estela Derazne1,
  8. Mario E Beiner1,2,
  9. Yfat Kadan2,
  10. Ami Fishman1,2,
  11. Jacob Korach1,3,
  12. Al Covens4,5 and
  13. Lilian Gien4,5
  1. 1 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  2. 2 Gynecologic Oncology, Meir Medical Center, Kfar Saba, Israel
  3. 3 Gynecologic Oncology, Sheba Medical Center, Ramat Gan, Israel
  4. 4 Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
  5. 5 Gynecologic Oncology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
  1. Correspondence to Limor Helpman, Juravinski Cancer Center, McMaster University, Hamilton, ON L8V5C2, Canada; helpmanl{at}


Objective High grade and non-endometrioid endometrial cancers carry a poor prognosis, and the lack of randomized prospective data has led to a wide range of practice regarding adjuvant therapy. The objective of this study was to evaluate the outcomes of different treatment strategies in patients with high-risk, early-stage endometrial cancer.

Methods Patients with high-grade endometrioid, serous endometrial cancer and carcinosarcoma diagnosed between 2000 and 2012 were identified from databases in three gynecologic oncology divisions, in Toronto and in Israel. Adjuvant treatment practices differed across the centers, creating a heterogeneous cohort. A comparison of stage I patients stratified by adjuvant treatment was undertaken. Log-rank tests and Cox proportional hazards models were employed to compare recurrence and survival across treatment groups.

Results 490patients with high risk endometrial cancer were identified, among them 213 patients with stage I disease. Israeli patients received more chemotherapy (41% vs 10% in stage I disease; P<0.001) than patients in Toronto. Chemotherapy was not associated with improved disease-free, disease-specific or overall survival, nor was it associated with fewer distant recurrences (50% vs 54%). Radiation was also not associated with improved recurrence or survival, nor did it affect the pattern of recurrence. On Cox multivariable analysis, neither radiation treatment nor chemotherapy were significantly associated with outcome (HR for recurrence, 0.72 for pelvic radiation (P=0.46) and 1.99 for chemotherapy (P=0.09); HR for death, 0.67 for pelvic radiation (P=0.29) and 1.03 for chemotherapy (P=0.94)).

Conclusions In this retrospective analysis, neither adjuvant radiation nor chemotherapy were associated with improved outcome in stage I, high risk endometrial cancer.

  • endometrial cancer
  • early endometrial cancer
  • high risk endometrial cancer
  • serous endometrial cancer
  • endometrial carcinosarcoma
  • adjuvant treatment
  • chemotherapy

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  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the institutional review boards of all participating institutions

  • Provenance and peer review Not commissioned; externally peer reviewed.