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Original Article
SATEN III—Splitting Adjuvant Treatment of stage III ENdometrial cancers: an international, multicenter study
  1. Ilker Kahramanoglu1,
  2. Mehmet Mutlu Meydanli2,
  3. Siarhei Taranenka3,
  4. Ali Ayhan4,
  5. Coskun Salman5,
  6. Muzaffer Sanci6,
  7. Fuat Demirkiran1,
  8. Firat Ortac7,
  9. Dimitrios Haidopoulos8,
  10. Vladyslav Sukhin9,
  11. Dilyara Kaidarova10,
  12. Artem Stepanyan11,
  13. Farah Farazaneh12,
  14. Shamistan Aliyev13,
  15. Elena Ulrikh14,
  16. Dina Kurdiani15,
  17. İbrahim Yalcin2,
  18. Siarhei Mavrichev3,
  19. Huseyin Akilli4,
  20. Mustafa Erkan Sarı2,
  21. Andrei Pletnev3,
  22. Koray Aslan2,
  23. Tugan Bese1,
  24. Murat Kairbayev16,
  25. Dimitrios Vlachos8 and
  26. Murat Gultekin5
  1. 1 Department of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
  2. 2 Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
  3. 3 Department of Gynecologic Oncology, N.N. Alexandrov Cancer Center of Belarus, Minsk, Belarus
  4. 4 Department of Gynecologic Oncology, Faculty of Medicine, Baskent University, Ankara, Turkey
  5. 5 Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
  6. 6 Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Faculty of Medicine,University of Health Sciences, Izmir, Turkey
  7. 7 Department of Gynecologic Oncology, School of Medicine, Ankara University, Ankara, Turkey
  8. 8 Gynecologic Oncology Unit, 1stDepartment of Obstetrics and Gynecology, Alexandra Hospital, University of Athens, Athens, Greee
  9. 9 Department of Oncogynecology, Grigoriev Institute for Medical Radiology, Kharkiv, Ukraine
  10. 10 Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
  11. 11 Department of Gynecologic Oncology, NAIRI Medical Center, Yerevan, Armenia
  12. 12 Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  13. 13 Department of Gynecologic Oncology, National Center of Oncology, Baku, Azerbaijan
  14. 14 Department of Oncogynecology, N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Russia
  15. 15 Gynaecological oncology Department, Tbilisi Cancer Center, Tbilisi, Georgia
  16. 16 Department of Gynecologic Oncology, Almaty Sema Hospital, Almaty, Kazakhstan
  1. Correspondence to Dr Ilker Kahramanoglu, Department of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey; ilkerkahramanoglu{at}gmail.com

Abstract

Introduction The purposes of this study were to compare adjuvant treatment modalities and to determine prognostic factors in stage III endometrioid endometrial cancer (EC).

Methods SATEN III was a retrospective study involving 13 centers from 10 countries. Patients who had been operated on between 1998 and 2018 and diagnosed with stage III endometrioid EC were analyzed.

Results A total of 990 women were identified; 317 with stage IIIA, 18 with stage IIIB, and 655 with stage IIIC diseases. The median follow-up was 42 months. The 5-year disease-free survival (DFS) of patients with stage III EC by adjuvant treatment modality was 68.5% for radiotherapy (RT), 54.6% for chemotherapy (CT), and 69.4% for chemoradiation (CRT) (p=0.11). The 5-year overall survival (OS) for those patients was 75.6% for RT, 75% for CT, and 80.7% for CRT (p=0.48). For patients with stage IIIA disease treated by RT versus CT versus CRT, the 5-year OS rates were 75.6%, 75.0%, and 80.7%, respectively (p=0.48). Negative peritoneal cytology (HR: 0.45, 95% CI: 0.23 to 0.86; p=0.02) and performance of lymphadenectomy (HR: 0.33, 95% CI: 0.16 to 0.77, p=0.001) were independent predictors for improved OS for stage IIIA EC. For women with stage IIIC EC treated by RT, CT, and CRT, the 5-year OS rates were 78.9%, 67.0%, and 69.8%, respectively (p=0.08). Independent prognostic factors for better OS for stage IIIC disease were age <60 (HR: 0.50, 95%CI: 0.36 to 0.69, p<0.001), grade 1 or 2 disease (HR: 0.59, 95% CI: 0.37 to 0.94, p=0.014; and HR: 0.65, 95%CI: 0.46 to 0.91, p=0.014, respectively), absence of cervical stromal involvement (HR: 063, 95% CI: 0.46 to 0.86, p=0.004) and performance of para-aortic lymphadenectomy (HR: 0.52, 95% CI: 0.35 to 0.72, p<0.001).

Discussion Although not statistically significant, CRT seemed to be a better adjuvant treatment option for stage IIIA endometrioid EC. Systematic lymphadenectomy seemed to improve survival outcomes in stage III endometrioid EC.

  • endometrial neoplasms
  • radiotherapy
  • lymphatic metastasis

https://doi.org/10.1136/ijgc-2019-000643

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    Footnotes

    • Contributors IK: Concept, design, monitored data collection, analysis, draft, writing the manuscript, final approval. MMM: Materials, supervision, interpretation of data, data curation, critical review, final approval. ST: Data collection, materials, final approval. AA: Materials, supervision, critical review, final approval. CS: Materials, data collection, interpretation of data, final approval. MS: Materials, data collection, review, final approval. FD: Materials, data collection, supervision, interpretation of data, final approval. FO: Materials, data collection, review, final approval. DH: Materials, data collection, critical review, analysis, final approval. VS: Materials, data collection, review, final approval. DK: Materials, data collection, interpretation of data, final approval. AS: Materials, data collection, review, final approval. FF: Materials, data collection, final approval. SA: Materials, data collection, review, final approval. EU: Materials, data collection, review, final approval. DK: Data collection, review, final approval. IY: Data collection, interpretation of data, data curation, review, final approval. SM: Data collection, review, final approval. HA: Data collection, review, final approval. MES: Concept, design, literature seach, review, final approval. AP: Data collection, interpretation of data, review, final approval. KA: Data collection, final approval. TB: Materials, review, final approval. MK: Materials, review, final approval. DV: Materials, review, final approval. MG: Materials, concept, design, monitored data collection, analysis, interpretation of data, critical review, final approval.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

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

    • Data availability statement Data may be obtained from a third party and are not publicly available.