J Gynecol Oncol.  2018 Sep;29(5):e76. 10.3802/jgo.2018.29.e76.

Treatment outcomes of patients with stage II pure endometrioid-type endometrial cancer: a Taiwanese Gynecologic Oncology Group (TGOG-2006) retrospective cohort study

• Fu HC
• Chen JR
• Chen MY
• Hsu KF
• Cheng WF
• Chiang AJ
• Ke YM
• Chen YC
• Chang YY
• Huang CY
• Kang CY
• Kan YY
• Hsiao SM
• Yen MS

• KMID: 2417456
• DOI: http://doi.org/10.3802/jgo.2018.29.e76

Abstract

OBJECTIVE
Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid endometrial cancer (EEC) is still controversial. Aims of this study were to evaluate survival benefits and adverse effects of different hysterectomies with or without adjuvant radiotherapy (RT), and to identify prognostic factors.
METHODS
The patients at 14 member hospitals of the Taiwanese Gynecologic Oncology Group from 1992 to 2013 were retrospectively investigated. Patients were divided into simple hysterectomy (SH) alone, SH with RT, radical hysterectomy (RH) alone, and RH with RT groups. Endpoints were recurrence-free survival (RFS), overall survival (OS), disease-specific survival (DSS), adverse effects and prognostic factors for survival.
RESULTS
Total of 246 patients were enrolled. The 5-year RFS, OS, DSS and recurrence rates for the entire cohort were 89.5%, 94.3%, 96.2% and 10.2%, respectively. Patients receiving RH had more adverse effects including blood loss (p < 0.001), recurrent urinary tract infections (p = 0.013), and leg lymphedema (p = 0.038). Age over 50-year (HR = 9.2; 95% confidence interval [CI], 1.2-70.9) and grade 3 histology (HR = 7.28; 95% CI, 1.45-36.6) were independent predictors of OS. Grade 3 histology was an independent predictor of RFS (HR = 5.13; 95% CI, 1.38-19.1) and DSS (HR = 5.97; 95% CI, 1.06-58.7). Patients receiving adjuvant RT had lower locoregional recurrence (p = 0.046), but no impact on survival.
CONCLUSION
Different treatment modalities yield similar survival outcomes. Patients receiving SH with RT had lower locoregional recurrent with acceptable morbidity. Age and tumor grading remained significant predictors for survival among patients with FIGO 2009 stage II EEC.

Keyword

Uterine cancer; Endometrioid; General Surgery; Radiotherapy; Survival; Recurrence

MeSH Terms

Cohort Studies*
Endometrial Neoplasms*
European Union
Female
Gynecology
Humans
Hysterectomy
Leg
Lymphedema
Neoplasm Grading
Obstetrics
Radiotherapy
Radiotherapy, Adjuvant
Recurrence
Retrospective Studies*
Urinary Tract Infections
Uterine Neoplasms