Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion: Is there a role for chemotherapy?

Autor: Beavis AL; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: abeavis2@jhmi.edu., Yen TT; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Stone RL; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Wethington SL; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Carr C; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA., Son J; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA., Chambers L; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA., Michener CM; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA., Ricci S; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA., Burkett WC; Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA., Richardson DL; Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA., Staley AS; Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA., Ahn S; Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA., Gehrig PA; Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA., Torres D; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA., Dowdy SC; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA., Sullivan MW; Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA., Modesitt SC; Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA., Watson C; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA., Veade A; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA., Ehrisman J; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA., Havrilesky L; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA., Secord AA; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA., Loreen A; Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, OH, USA., Griffin K; Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, OH, USA., Jackson A; Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, OH, USA., Viswanathan AN; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA., Jager LR; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Fader AN; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2020 Mar; Vol. 156 (3), pp. 568-574. Date of Electronic Publication: 2020 Jan 14.
DOI: 10.1016/j.ygyno.2019.12.028
Abstrakt: Objectives: Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/-RAD.
Methods: This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/-lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/-RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models.
Results: In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/-RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/-RAD (HR = 0.18, 95% CI: 0.09-0.39) and RAD (HR = 0.31, 95% CI: 0.18-0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/-RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12-0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03-0.32). Overall survival did not differ by treatment.
Conclusions: In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.
Competing Interests: Declaration of competing interest All authors reported their potential conflicts of interest, and there were not relevant conflicts of interest disclosed.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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