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. 2019 Jul 18;16(14):2561.
doi: 10.3390/ijerph16142561.

Impact of Adjuvant Modalities on Survival in Patients with Advanced Stage Endometrial Carcinoma: A Retrospective Analysis from a Tertiary Medical Center

Yi-Jou Tai  1   2 , Heng-Cheng Hsu  1   2   3 , Ying-Cheng Chiang  1   2 , Yu-Li Chen  1   4 , Chi-An Chen  1 , Wen-Fang Cheng  5   6   7
Affiliations

Impact of Adjuvant Modalities on Survival in Patients with Advanced Stage Endometrial Carcinoma: A Retrospective Analysis from a Tertiary Medical Center

Yi-Jou Tai et al. Int J Environ Res Public Health. .

Abstract

Adjuvant treatment in advanced-stage (stages III /IV) endometrial carcinomas in terms of tumor grades has not yet been explored. We retrospectively analyzed 194 patients with advanced-stage endometrioid endometrial carcinoma who received surgery, followed by adjuvant therapy, at National Taiwan University Hospital between January 1, 2000 and August 31, 2017. Adjuvant therapies included radiation (RT), chemotherapy alone (CT), and combined modality treatment (CMT: radiation and chemotherapy). The prognostic factors were determined from multivariate survival analyses using Cox regression models. Progression-free survival (PFS) and overall survival (OS) times were estimated with the Kaplan-Meier method. The median follow-up was 45.5 months (range: 6.2-207.9). In grade 1/2 endometrioid carcinoma, neither adjuvant CT nor CMT could prolong PFS significantly compared to RT (CT: HR 1.59, 95% CI 0.64-3.97; CMT: HR 2.03, 95% CI 0.72-5.74). Notably, maximal cytoreduction independently improved PFS (HR 0.31, 95% CI 0.10-0.90). No particular adjuvant treatment provided an OS advantage over the others for grade 1/2 endometrioid carcinomas. However, for grade 3 endometrioid carcinoma, CMT showed OS benefits (HR 0.15, 95% CI 0.03-0.89) compared to RT and CT. In conclusion, maximal cytoreduction should be the goal in patients with grade 1/2 advanced-stage endometrioid carcinomas. Based on our results, patients with grade 3 endometrioid carcinomas might benefit from adjuvant CMT.

Keywords: adenocarcinoma; adjuvant; chemotherapy; endometrial neoplasms; endometrioid; radiotherapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study population.
Figure 2
Figure 2
Distribution of adjuvant therapies. The number of patients in each stage is indicated in parentheses. The labels displayed in each chart represent the percentages of patients who received the different adjuvant therapies.
Figure 3
Figure 3
Kaplan–Meier estimates of survival for 194 patients with advanced-stage endometrioid endometrial carcinoma. (A) Progression-free survival; (B) overall survival. Four distinct subgroups represent different disease stages and tumor grades.
Figure 4
Figure 4
Survival of 127 patients with grade 1/2 tumors, stratified by different adjuvant modalities. (A) Progression-free survival; (B) overall survival.
Figure 5
Figure 5
Survival of 67 patients with grade 3 tumors, stratified by different adjuvant modalities. (A) Progression-free survival; (B) overall survival.
See this image and copyright information in PMC

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