Evaluation of Survival, Recurrence Patterns and Adjuvant Therapy in Surgically Staged High-Grade Endometrial Cancer with Retroperitoneal Metastases

Abstract

Background: We seek to evaluate the difference in recurrence patterns and survival among stage IIIC high-grade endometrial cancer treated with surgery followed by adjuvant chemotherapy alone, radiation therapy alone, or both (chemoradiation).

Methods: A multicenter retrospective analysis of surgically staged IIIC HGEC receiving adjuvant therapy was conducted. HGEC was defined as grade 3 endometrioid adenocarcinoma, serous, clear cell and carcinosarcoma. Differences in the frequency of recurrence sites and treatment delays were identified using Pearson's χ² test. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier estimates.

Results: A total of 155 patients were evaluable: 41.9% carcinosarcoma, 36.8% serous, 17.4% grade 3 and 3.9% clear cell. Of these, 67.1% received chemoradiation, 25.8% received chemotherapy and 7.1% received radiation therapy. There was no difference in the frequency of treatment delays between regimens (p = 0.571). There was a trend towards greater retroperitoneal recurrence with chemotherapy (25.9%) versus chemoradiation (8.4%) and radiation therapy (7.7%) (p = 0.252). Grade 3 tumors had improved progression-free and overall survival (26 and 42 months, respectively) versus serous (17 and 30 months, respectively), carcinosarcoma (14 and 24 months, respectively) and clear cell (24 and 30 months respectively) (p = 0.002, p < 0.001). Overall, chemoradiation was superior to chemotherapy and radiation therapy in PFS (p < 0.001) and OS (p < 0.001). Upon multivariate analysis, only histology and receipt of chemoradiation were independent predictors of survival.

Conclusion: The majority of stage IIIC high-grade endometrial carcinomas recurred. Chemoradiation was associated with improved survival and less retroperitoneal recurrence. Grade 3 tumors demonstrated improved survival versus other histologies regardless of adjuvant treatment modality.

Keywords: chemoradiation; endometrial cancer; retroperitoneal metastasis.

Figure 1

Kaplan–Meier survival analysis by histology. (A) Progression-free survival analysis; (B) overall survival analysis; CC: clear cell; CS: carcinosarcoma; G3 Endo: grade 3 endometrioid.

Figure 2

Kaplan–Meier survival analysis based on adjuvant treatment regimen. (A) Progression free survival analysis; (B) overall survival analysis; CT: chemotherapy alone; CRT: chemoradiation; RT: radiation therapy.

Figure 2

Kaplan–Meier survival analysis based on adjuvant treatment regimen. (A) Progression free survival analysis; (B) overall survival analysis; CT: chemotherapy alone; CRT: chemoradiation; RT: radiation therapy.