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  • 224 Adjuvant chemotherapy in surgical stage I or II endometrioid endometrial cancer with myometrial invasion >50%: a multicenter retrospective study with long-term follow-up

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Poster
IGCS20_1225
224 Adjuvant chemotherapy in surgical stage I or II endometrioid endometrial cancer with myometrial invasion >50%: a multicenter retrospective study with long-term follow-up
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  1. S Garzon1,
  2. F Multinu2,
  3. A Weaver3,
  4. ME McGree3,
  5. E Sartori4,
  6. F Landoni5,
  7. P Zola6,
  8. G Dinoi1,
  9. G Aletti2,
  10. A Gadducci7 and
  11. A Mariani1
  1. 1Department of Gynecology and Obstetrics, Mayo Clinic, USA
  2. 2Division of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Italy
  3. 3Division of Biomedical Statistics and Informatics, Mayo Clinic, USA
  4. 4Department of Gynecology and Obstetrics, University of Brescia, Italy
  5. 5Department of Medicine and Surgery, Clinic of Obstetrics and Gynecology, San Gerardo Hospital Monza, University of Milan Bicocca, Italy
  6. 6Department of Surgical Sciences, University of Turin, Italy
  7. 7Department of Medical Oncology, Mayo Clinic, USA

Abstract

Objective To evaluate the role of adjuvant chemotherapy in patients with surgical stage I-II endometrioid endometrial cancer (EC) with myometrial invasion (MI) >50%.

Methods We identified patients with stage I-II endometrioid grade 2 and 3 EC with MI >50% and negative nodes after pelvic ± para-aortic lymphadenectomy at four institutions (US and Italy). The association between adjuvant chemotherapy and cause-specific survival (CSS) or progression-free survival (PFS) was assessed with Cox proportional hazards models, adjusted for confounders using the inverse-probability of treatment weighting (IPTW).

Results From 1984 to 2012, 329 patients were identified. Median follow-up among those alive was 7.0 (interquartile range, 3.7–11.1) years. Five-year CSS was 86.1% (95%CI: 82.0–90.4%) and 5-year PFS was 82.2% (95%CI: 77.9–86.8%). Stage II (vs stage IB) was significantly associated with poorer CSS and PFS; older age with poorer PFS. With IPTW-adjusted analysis, adjuvant chemotherapy appeared to improve CSS (hazard ratio [HR]: 0.34; 95%CI: 0.11–1.03; P=.06) and nonvaginal PFS (HR: 0.36; 95%CI: 0.12–1.08; P=.07) (figures 1 and 2). Eleven (84.6%) of 13 para-aortic recurrences were observed in 194 patients who had neither para-aortic lymphadenectomy nor adjuvant chemotherapy. Conversely, no para-aortic recurrences were observed in 64 patients who received adjuvant chemotherapy.

Abstract 224 Figure 1
Abstract 224 Figure 1

Inverse-probability of treatment-weighted cause-specific survival (A), and nonvaginal progression-free survival (B), according to receipt of adjuvant chemotherapy

Abstract 224 Figure 2
Abstract 224 Figure 2

Inverse-probability of treatment-weighted cause-specific survival among patients with FIGO stage IB (A) or stage II (B), according to receipt of adjuvant chemotherapy

Conclusions Adjuvant chemotherapy for surgical stage I-II endometrioid grade 2 and 3 EC with MI >50% appeared to improve CSS and nonvaginal PFS, although not meeting the conventional level of statistical significance. Stage II patients appear to benefit most from adjuvant chemotherapy. Chemotherapy ± para-aortic lymphadenectomy may help reduce para-aortic failures.

https://doi.org/10.1136/ijgc-2020-IGCS.192

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