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Adjuvant treatment and outcomes for patients with stage IIIA grade 1 endometrioid endometrial cancer
  1. Mary Katherine Montes de Oca1,
  2. Benjamin B Albright2,
  3. Angeles Alvarez Secord2,
  4. Laura J Havrilesky2 and
  5. Haley A Moss2
  1. 1Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
  2. 2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr Mary Katherine Montes de Oca, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710-4699, USA; mm765{at}duke.edu

Abstract

Objective The role and type of adjuvant therapy for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIA grade 1 endometrioid endometrial adenocarcinoma are controversial. This retrospective cohort study aimed to determine associations between adjuvant therapy use and survival among patients with stage IIIA grade 1 endometrial cancer.

Methods Patients who underwent primary surgery for stage IIIA (FIGO 2009 staging) grade 1 endometrial cancer between January 2004 and December 2016 were identified in the National Cancer Database. Demographics and receipt of adjuvant therapy were compared. Overall survival was analyzed using Kaplan–Meier curves, log-rank test, and multivariable Cox proportional hazard models.

Results Of 1120 patients, 248 (22.1%) received no adjuvant treatment, 286 (25.5%) received chemotherapy alone, 201 (18.0%) radiation alone, and 385 (34.4%) chemotherapy and radiation. Five-year overall survival rate was 83.0% (95% CI 80.1% to 85.6%). Older age, increasing comorbidity count, and lymphovascular space invasion status were significant negative predictors of survival. Over time, there was an increasing rate of chemotherapy (45.4% in 2004–2009 vs 69.2% in 2010–2016; p<0.001). In the multivariable analysis, chemotherapy was associated with significantly improved overall survival compared with no adjuvant therapy (HR 0.49 (95% CI 0.31 to 0.79); p=0.003). There was no survival association when comparing radiation alone with no treatment, and none when adding radiation to chemotherapy compared with chemotherapy alone. Those with lymphovascular space invasion (n=124/507) had improved overall survival with chemotherapy and radiation (5-year overall survival 91.2% vs 76.7% for chemotherapy alone and 27.3% for radiation alone, log-rank p<0.001), but there was no survival difference after adjusting for age and comorbidity (HR 0.25 (95% CI 0.05 to 1.41); p=0.12).

Conclusions The use of adjuvant chemotherapy for the treatment of stage IIIA grade 1 endometrial cancer increased over time and was associated with improved overall survival compared with radiation alone or chemoradiation. Patients with lymphovascular space invasion may benefit from combination therapy.

  • endometrial neoplasms
  • radiotherapy

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @BenAlbrightMD

  • Contributors MKM: guarantor, manuscript author, data compilation. BBA: NCDB search, data abstraction and compilation, statistical analysis, manuscript review and editing. AAS: manuscript review and editing. LH: manuscript review and editing. HAM: manuscript review and editing.

  • 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 AAS does not have any related conflict of interests for this manuscript. Her institution has received clinical trial grant funding from AbbVie, Amgen, Astra Zeneca, Boehringer Ingelheim, Clovis, Eisai, Immutep, Merck, Oncoquest PharmaMar, Roche/Genentech, Seagen, Tesaro/GSK, VBL Therapeutics, and National Cancer Trial Network. She has received honoraria for Advisory Boards from Aravive, AstraZeneca, Clovis, Cordgenics, Eisai, Merck, Mersana, Myriad, Oncoquest, Roche/Genentech, and Tesaro/GSK. She has participated in Advisory Boards (uncompensated) for AbbVie and Regeneron; on Clinical Trial Steering Committees (uncompensated) for the AtTEnd trial (Hoffman-LaRoche), the Oval Trial (VBL Therapeutics), and the FLORA-5 trial (Oncoquest); and on the SGO Board of Directors, GOG Foundation Board of Directors, and AAOGF Board of Trustees (all uncompensated) within the past 36 months.

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

  • 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.

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