Table 3

Literature review

StudyTypeInclusion criteriaAdjuvant treatmentOutcomeConclusion
Nasioudis et al10 Retrospective cohort (n=1709)
National Cancer Database (USA)
  • Stage IA

  • Serous carcinoma

  • Limited to a polyp or the endometrium

  • No adjuvant treatment

    (n=833, 48.7%)

  • CT only (n=353, 20.7%)

  • CT+RT (n=348, 20.4%), 80% brachy only

  • RT only (n=175, 10.2%)

  • Median F/U: 58.55 months

  • 5-year OS 81.9% in observation group compared with 91.3% in CT+RT and 85% RT only (p=0.001)

  • OS better in CT+RT group compared with observation (HR 0.55, CI 95% 0.35–0.88) and CT group (HR 0.64, CI 95% 0.35–0.8)

  • PFS unknown (cause of death N/A in database)

No difference between CT and CT-RT
Better OS if CT or CT+RT compared with observation
Mandato et al12 Retrospective cohort
n=75, 66 patients with stage IA
  • Retrospective data from 7 gynecology-oncology centers in Italy

  • Patients with USC confined to a polyp of any stage (88% stage IA)

  • No adjuvant treatment in 50 patients (66.7%)

  • Adjuvant treatment in 25 patients, including 24.2% with FIGO IA

    • RT (4%)

    • CT (88%)

    • Brachy (8%)

    • 12% patients (n=9) upstaged to stage II-IV (all received adjuvant treatment)

  • Median F/U 40 months

  • 45% had complete surgical staging (including para-aortic LN and omentectomy), 45% had incomplete staging and 13.3% no staging

  • Patients with stage IA complete staging and no adjuvant Tx had a risk of relapse of 5.2%

  • Patients with stage IA, complete staging, and adjuvant treatment had a risk of recurrence of 12.5%

Complete surgical staging and HTN were associated with lower risk of relapse (especially compared with no staging)
No impact of adjuvant treatment
Boyraz et al13 Retrospective cohort study
n=182 patients n=20 for patients with USC confined to the endometrium
Patients with USC confined to the endometrium with or without metastatic disease
  • 20 patients had stage IA confined to the endometrium

  • Observation (70%)

  • Brachy (20%)

  • CT+brachy (5%

  • CT (5%)

  • Mean F/U 31 months

  • 6 patients with disease confined to the uterus had adjuvant treatment (30%)

  • OS and PFS similar for patients who received adjuvant treatment compared with observation (p=0.25 and p=0.30, respectively)

No impact of adjuvant treatment
Liang et al9 Retrospective cohort (n=85)
  • Stage IA

  • High-grade EC

  • Limited to a polyp (57.6%) or without myometrial invasion (24.4%)

  • LVSI excluded

  • No adjuvant treatment (23.5%, 9 because of patient refusal)

  • CT±RT (58.1%)

  • Brachy (24.7%)

  • Median F/U 46.5 months

  • 5 recurrences:

    • 4 had received adjuvant therapy (3 CT +brachy and 1 brachy)

  • PFS and OS rate at 3 years: 94.9% and 98.8%, respectively

No impact of adjuvant treatment on outcome
Mahdi et al14 Retrospective cohort study
(n=115)
  • Stage IA non-invasive USC

  • Surgical staging including pelvic LNP (84%), omentectomy 57%

  • Observation (37.4%)

  • CT (18.3%)

  • CT+brachy (23.5%)

  • CT+RT (1.7%)

  • CT+RT+brachy (0.9%)

  • RT+brachy (4.4%)

  • Mean F/U 52 months

  • Mean PFS 53.2 and mean OS 68.9 months

  • CT did not impact on mean PFS and OS (recurrences of 25.5% vs 26.9%, p=0.85)

No impact of adjuvant treatment
Staging LNP had an impact on recurrence rate
van der Putten et al11 Retrospective cohort study
(Stage IA without myometrial invasion n=41)
  • USC stage I (at least 10% of serous)

  • Surgical staging with at least a hysterectomy and salpingo-oophorectomy

    • Pelvic LNP in 66%

    • No omental biopsy in 51.2%

  • Observation (73.1%)

  • Brachy (5%)

  • CT (2.4%)

  • CT+RT (19.5%)

  • 5-year disease-free survival of 80.7%

  • Recurrence rate of 12.2%

    • 10% in observation and 18% in adjuvant treatment group (p=0.6)

  • 72.2% of recurrences were distant

  • Few para-aortic and omental recurrences

No impact of adjuvant treatment on outcomes
Chang-Halpenny et al8 Retrospective cohort (n=51)
  • Stage IA

  • Serous carcinoma or clear cell

  • Limited to a polyp or endometrium

  • 5 had myometrial invasion (9.8%)

  • No adjuvant treatment (n=40, 80%)

  • Adjuvant treatment if myometrial invasion, positive peritoneal washings, or incomplete staging

    • CT+RT (n=6, 12%)

    • CT (n=3, 6%)

  • Brachy only (n=1, 2%)

  • Median F/U 45.2 months

  • 4 recurrences with carcinomatosis or pelvic lymph nodes (7.8%)

  • 11 deaths: 3 from EC, 2 new gynecologic cancer, 6 from non-malignant conditions

  • PFS and OS at 5 years: 93% and 80.6%, respectively

No impact of adjuvant treatment on outcome
Fader et al15 Retrospective cohort (n=54)
*Entire cohort n=206
  • Stage IA

  • Serous carcinoma

  • No adjuvant treatment

    (n=21, 38.9%)

  • CT (n=28, 51.9%)

  • Brachy (n=5, 9.3%)

  • For the stage IA subgroup:

  • Median F/U 27 months

  • 6 recurrences (11.1%)

  • OS or PFS not available

  • For the entire cohort: substage (p=0.005) and CT (p=0.001) associated with better PFS

  • Recurrences: 21.4%

  • 31.1% in observation group

  • 38.3% in RT group

  • 10.5% in CT group (p=0.001)

Impact of adjuvant treatment (CT) on outcome for the entire cohort
Not evaluable for the stage IA subgroup
Dallaire-Nantel et alRetrospective cohort (n=25)
  • Stage IA

  • Type II endometrial carcinoma

  • Limited to a polyp or the endometrium

  • No adjuvant treatment

    (n=19, 76%)

  • Brachy (n=6, 24%)

  • No patients received CT

  • Median F/U 44 months

  • 3 recurrences (12%)

  • PFS and OS at 3 years: 91% and 100%, respectively

No impact of adjuvant treatment on outcome
  • brachy, brachytherapy; CI, confidence interval; CT, chemotherapy; CT-RT, chemoradiation; EC, endometrial cancer; FIGO, International Federation of Gynecology and Obstetrics; F/U, follow-up; HR, hazard ratio; HTN, hypertension; LN, lymph node; LNP, pelvic lymph node; LVSI, lymphovascular space invasion; N/A, not available; OS, overall survival; PFS, progression-free survival; RT, radiotherapy; Tx, treatment; USC, uterine serous carcinoma.