Introduction/Background*Treatment for endometrial cancer consists of surgery followed by appropriate risk adapted adjuvant treatment. Pooled analysis from the PORTEC-1 and -2 trials was used in development of nomograms that incorporated mode of adjuvant treatment in predicting risk of recurrence. In the present study, we have validated performance of the PORTEC nomograms in patients with early endometrial cancer treated at a single tertiary cancer centre in India.
Methodology A retrospective analysis of patients of endometrial cancer treated with Observation (Obs), Vaginal Brachytherapy (VBT), or External beam Radiotherapy (EBRT) as adjuvant post-surgery was carried out. All patients were with endometrioid histology and had Stage I (FIGO 2009) disease. Patients who received chemotherapy were excluded. Three-hundred and eighteen patients treated between 2009-18 were included. Nomogram validation was performed by calculation of Concordance Index using Harrell’s estimator.
Result(s)*Median age at diagnosis was 57 years (IQR 52-63 yrs). 201 (63.2%) patients had Stage IA disease, while 117 (36.8%) patients had Stage IB disease at presentation. According to the ESMO-ESGO-ESTRO 2016 risk stratification 168 (52.8%) patients were low risk, 76 (23.9%) patients were intermediate, 42 (13.2%) were high-intermediate and 32 (10.1%) patients were high risk. Lymphovascular space invasion was seen in 22 (7%) patients. The adjuvant therapy offered was Observation in 136 (42.8%) patients, VBT in 109 (34.2%) patients and EBRT in 73 (23%) patients. With a median follow-up of 40 months the loco-regional control, distant-relapse free survival, disease-free and over-all survival at 3-yrs were 97%, 97.3%, 94.8% and 97.8% respectively. Concordance index for Overall Survival (OS) was 0.72 (95% C.I: 0.45-0.99), for Disease-free survival (DFS) was 0.74 (95% C.I.0.66-0.83) and for Distant Relapse was 0.65 (95% C.I. 0.54-0.77). Concordance index for loco-regional recurrence could not be reliably derived.
Conclusion*The PORTEC nomograms for DFS and OS were validated in patients with stage I endometrial cancer in an Indian cohort and could be used for shared decision making regarding adjuvant treatment in patients with early endometrial cancer.
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