Adjuvant treatment improves overall survival in women with high-intermediate risk early-stage endometrial cancer with lymphovascular space invasion

Ji Son, Laura M. Chambers, Caitlin Carr, Chad M. Michener, Meng Yao, Anna Beavis, Ting Tai Yen, Rebecca L. Stone, Stephanie L. Wethington, Amanda N. Fader, Wesley C. Burkett, Debra L. Richardson, Allison S. Staley, Susie Ahn, Paola A. Gehrig, Diogo Torres, Sean C. Dowdy, MacKenzie W. Sullivan, Susan C. Modesitt, Catherine WatsonAshley Veade, Jessie Ehrisman, Laura Havrilesky, Angeles Alvarez Secord, Amy Loreen, Kaitlyn Griffin, Amanda Jackson, Akila Viswanathan, Stephanie Ricci

Research output: Contribution to journalArticlepeer-review

Abstract

Background Adjuvant therapy in early-stage endometrial cancer has not shown a clear overall survival benefit, and hence, patient selection remains crucial. Objective To determine whether women with high-intermediate risk, early-stage endometrial cancer with lymphovascular space invasion particularly benefit from adjuvant treatment in improving oncologic outcomes. Methods A multi-center retrospective study was conducted in women with stage IA, IB, and II endometrial cancer with lymphovascular space invasion who met criteria for high-intermediate risk by Gynecologic Oncology Group (GOG) 99. Patients were stratified by the type of adjuvant treatment received. Clinical and pathologic features were abstracted. Progression-free and overall survival were evaluated using multivariable analysis. Results 405 patients were included with the median age of 67 years (range 27-92, IQR 59-73). 75.0% of the patients had full staging with lymphadenectomy, and 8.6% had sentinel lymph node biopsy (total 83.6%). After surgery, 24.9% of the patients underwent observation and 75.1% received adjuvant therapy, which included external beam radiation therapy (15.1%), vaginal brachytherapy (45.4%), and combined brachytherapy + chemotherapy (19.1%). Overall, adjuvant treatment resulted in improved oncologic outcomes for both 5-year progression-free survival (77.2% vs 69.6%, HR 0.55, p=0.01) and overall survival (81.5% vs 60.2%, HR 0.42, p<0.001). After adjusting for stage, grade 2/3, and age, improved progression-free survival and overall survival were observed for the following adjuvant subgroups compared with observation: External beam radiation (overall survival HR 0.47, p=0.047, progression-free survival not significant), vaginal brachytherapy (overall survival HR 0.35, p<0.001; progression-free survival HR 0.42, p=0.003), and brachytherapy + chemotherapy (overall survival HR 0.30 p=0.002; progression-free survival HR 0.35, p=0.006). Compared with vaginal brachytherapy alone, external beam radiation or the addition of chemotherapy did not further improve progression-free survival (p=0.80, p=0.65, respectively) or overall survival (p=0.47, p=0.74, respectively). Conclusion Adjuvant therapy improves both progression-free survival and overall survival in women with early-stage endometrial cancer meeting high-intermediate risk criteria with lymphovascular space invasion. External beam radiation or adding chemotherapy did not confer additional survival advantage compared with vaginal brachytherapy alone.

Original languageEnglish (US)
Pages (from-to)1738-1747
Number of pages10
JournalInternational Journal of Gynecological Cancer
Volume30
Issue number11
DOIs
StatePublished - Nov 1 2020

Keywords

  • endometrium
  • lymphatic vessels
  • pathology
  • uterine cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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