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Role of adjuvant chemotherapy in patients with FIGO stage IB grade 3 endometrial endometrioid adenocarcinoma treated with surgery and post-operative radiotherapy
  1. Leonid B Reshko1,
  2. Jeremy T Gaskins2,
  3. Sara M Dryden3,
  4. Daniel S Metzinger4,
  5. Sarah L Todd4,
  6. Harriet B Eldredge-Hindy5 and
  7. Scott R Silva1
  1. 1Department of Radiation Oncology, University of Louisville, Louisville, Kentucky, USA
  2. 2Department of Bioinformatics & Biostatistics, University of Louisville, Louisville, Kentucky, USA
  3. 3Department of Medical Education, University of Louisville, Louisville, Kentucky, USA
  4. 4Department of Gynecologic Oncology, University of Louisville, Louisville, Kentucky, USA
  5. 5Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Scott R Silva, Department of Radiation Oncology, University of Louisville, Louisville KY 40202, USA; scott.silva{at}


Background The optimal treatment of patients with FIGO stage IB grade 3 endometrial endometrioid adenocarcinoma remains unknown.

Objective To compare overall survival following treatment with a hysterectomy and adjuvant radiotherapy with or without chemotherapy in this group of patients.

Methods Patients diagnosed between January 2004 and January 2016 with FIGO stage IB grade 3 endometrial endometrioid adenocarcinoma treated with hysterectomy and postoperative radiotherapy with or without adjuvant concurrent chemotherapy were identified in the National Cancer Database. Overall survival was assessed with Kaplan-Meier curves. A Cox model was constructed to evaluate survival after controlling for confounding variables. A logistic regression model was used to reveal predictors of chemotherapy use.

Results A total of 2173 patients were included. The receipt of chemotherapy was associated with an increased 5-year overall survival from 67.6% to 75.6% (p=0.0313). This association trended toward statistical significance on multivariate analysis (adjusted HR (aHR) 0.80; 95% CI 0.63 to 1.01; p=0.0653). Other factors associated with improved survival were undergoing a lymphadenectomy, absence of lymphovascular space invasion, younger age, smaller tumor size, non-black race, and absence of comorbidities. Patients who underwent brachytherapy, had lymphovascular space invasion, were younger, were diagnosed in the more recent years, and were treated in higher volume centers were more likely to receive adjuvant chemotherapy.

Conclusion Adjuvant chemotherapy and radiation therapy were associated with an increase in survival in patients with FIGO stage IB grade 3 endometrial endometrioid adenocarcinoma compared with those treated with adjuvant radiotherapy alone.

  • uterine cancer
  • endometrial neoplasms
  • neoplasms
  • endometrium
  • radiation oncology

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  • Contributors LBR, JTG, SRS: conceptualization, methodology, validation, formal analysis, investigation, resources, writing, editing, visualization, supervision, project administration. SMD, DSM, SLT, HBE-H: conceptualization, methodology, writing, editing, visualization.

  • 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.

  • Ethics approval The study was found to be exempt from institutional review board review through 45 CFR 46.116 (D) by our institution’s Biomedical Institutional Review Board.

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

  • Data availability statement Data are available upon reasonable request. The National Cancer database file can be obtained from the American College of Surgeons.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.