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Observational Study
. 2017 Sep;116(4):482-491.
doi: 10.1002/jso.24690. Epub 2017 May 25.

Patient compliance for postoperative radiotherapy and survival outcome of women with stage I endometrioid endometrial cancer

Koji Matsuo  1   2 , Hiroko Machida  1 , Omar M Ragab  3 , Jocelyn Garcia-Sayre  1 , Annie A Yessaian  1   2 , Lynda D Roman  1   2
Affiliations
Observational Study

Patient compliance for postoperative radiotherapy and survival outcome of women with stage I endometrioid endometrial cancer

Koji Matsuo et al. J Surg Oncol. 2017 Sep.

Abstract

Background and objectives: To examine characteristics and survival outcome of women with endometrial cancer who declined postoperative radiotherapy.

Methods: A retrospective study was conducted to examine surgically-treated grade 1-2 stage IB and grade 3 stage IA-IB endometrioid endometrial cancer in the Surveillance, Epidemiology, and End Results Program between 1983 and 2013 (n = 10 613). Associations of patient declination for guideline-based postoperative radiotherapy and clinico-pathological demographics or survival outcome were examined on multivariable analysis.

Results: There were 323 (3.0%) women who declined adjuvant radiotherapy. Women who declined postoperative radiotherapy were more likely to be older, White, Western U.S. residents, and register in recent years (all, adjusted-P < 0.05). On multivariable analysis, patient declination for guideline-based postoperative radiotherapy remained an independent prognostic factor for decreased endometrial cancer-specific survival in unstaged grade 1-2 stage IB or staged/unstated grade 3 stage IA-IB diseases (adjusted-hazard ratio 1.84, 95% confidence interval 1.34-2.51, P = 0.001). Association of patient declination for guideline-based postoperative radiotherapy and decreased overall survival remained independent in the entire cohort on multivariable analysis (adjuvant-hazard ratio 1.71, 95% confidence interval 1.44-2.02, P < 0.001).

Conclusions: Our study suggested that patient compliance to guideline-based postoperative radiotherapy is a prognostic factor for women with stage I endometrioid endometrial cancer.

Keywords: adjuvant radiotherapy; compliance; endometrial cancer; survival outcome.

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Conflict of interest statement

DISCLOSURE

There is no conflict of interest in all the authors.

Figures

FIGURE 1
FIGURE 1
Selection criteria. EMCA, endometrial cancer; G, grade; and RT, radiotherapy. *Including unknown radiation modality type
FIGURE 2
FIGURE 2
Survival curves for cause-specific survival. Log-rank test for P-value. Survival curves were constructed per the Kaplan-Meier method for cause-specific survival for grade 1-2 stage IB disease with lymphadenectomy (panel A), grade 1-2 stage IB disease without lymphadenectomy (panel B), grade 3 stage IA-IB disease with lymphadenectomy (panel C), and grade 3 stage IA-IB without lymphadenectomy (panel D). LND, pelvic lymphadenectomy
FIGURE 3
FIGURE 3
Survival curves for overall survival. Log-rank test for P-value. Survival curves were constructed per the Kaplan-Meier method for overall survival for grade 1-2 stage IB disease with lymphadenectomy (panel A), grade 1-2 stage IB disease without lymphadenectomy (panel B), grade 3 stage IA-IB disease with lymphadenectomy (panel C), and grade 3 stage IA-IB without lymphadenectomy (panel D). LND, pelvic lymphadenectomy
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