J Gynecol Oncol.  2020 Nov;31(6):e84. 10.3802/jgo.2020.31.e84.

Management of stage II endometrial cancer and subsequent oncologic outcomes: a National Cancer Database study

• Vetter MH
• Bixel K
• Felix AS

• KMID: 2512053
• DOI: http://doi.org/10.3802/jgo.2020.31.e84

Abstract

Objective
The management of stage II endometrial cancer (EC) is challenging due to the wide variation in surgical practice and adjuvant treatment recommendations. We sought to describe the treatment patterns for patients with stage II EC and to evaluate the association between surgical management and adjuvant therapy on survival outcomes in a large cohort of patients with stage II EC.
Methods
Using data from the National Cancer Database, we identified 9,690 women with stage II EC. We used logistic regression to identify association of sociodemographic and tumor characteristics with surgery type and receipt of adjuvant therapy. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between adjuvant therapy, hysterectomy type, and overall survival.
Results
Almost 11% of the cohort underwent radical hysterectomy; however, there was no difference in survival between surgical types even when adjusted for adjuvant therapy (HR=0.94; 95% CI=0.82–1.07). Compared to no adjuvant treatment, radiation only (HR=0.66; 95% CI=0.61–0.73) and combination radiation and chemotherapy (HR=0.53; 95% CI=0.45–0.62) were associated with lower risk of death. There was no survival benefit of chemotherapy alone even when separated by histologic subtype (HR range, 0.55–1.46).
Conclusions
Women with stage II EC do not appear to benefit from routine radical hysterectomy though all patients appear to benefit from receipt of radiation therapy (RT), regardless of modality. Additionally, there may be an added survival benefit with the combination of computed tomography and RT in patients with non-endometrioid, high-risk histologies.

Keyword

Endometrial Cancer; Radiation Therapy; Hysterectomy; Intracavity Radiotherapy; Adjuvant Chemotherapy