Outcomes of Patients with Surgically and Pathologically Staged IIIA-IVB Pure Endometrioid-type Endometrial Cancer
Journal
Medicine (United States)
Journal Volume
95
Journal Issue
15
Date Issued
2016
Author(s)
Chen, Jen-Ruei
Chang, Ting-Chang
Fu, Hung-Chun
Lau, Hei-Yu
Ke, Yu-Min
Liang, Yu-Ling
Chiang, An-Jen
Huang, Chia-Yen
Chen, Yu-Chieh
Hong, Mun-Kun
Wang, Yu-Chi
Huang, Kuo-Feng
Hsiao, Sheng-Mou
Wang, Peng-Hui
Abstract
In the management of patients with advanced-stage pure endometrioid-type endometrial cancer (E-EC), such as positive lymph nodes (stage III) or stage IV, treatment options are severely limited. This article aims to investigate the outcome of women with FIGO III-IV E-EC (based on FIGO 2009 system). The retrospective cohort study, based on the Taiwanese Gynecologic Oncology Group (TGOG-2005), enrolled patients undergoing staging surgery to have a pathologically confirmed FIGO III-IV E-EC from 22-member hospitals between 1991 and 2010. This cohort included 541 patients (stage III, n=464; stage IV, n=77). Five-year overall survival (OS) was 70.4%. Median progression-free survival (PFS) was 43 months (range 0-258 months) and median OS was 52 months (range 1-258 months). Multivariate analysis showed that FIGO stage, >1/2 myometrial invasion (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.12-2.09; P=0.007), histological grade 3 (HR 2.0, 95% CI 1.47-2.75; P<0.001), and metastases of pelvic and para-aortic lymph nodes (PLN and PALN) (HR 2.75, 95% CI 1.13-6.72; P<0.001) were independent risk factors for PFS. FIGO stage, >1/2 myometrial invasion (HR 1.89, 95% CI 1.34-2.64; P<0.001), and histological grade 3 (HR 2.42, 95% CI 1.75-3.35; P<0.001) influenced OS. Complete dissection of PLN and PALN (HR 0.27, 95% CI 0.16-0.45; P<0.001, and HR 0.14, 95% CI 0.08-0.26; P<0.001) and the following paclitaxel-based therapy (HR 0.61, 95% CI 0.79-0.92; P=0.017, and HR 0.48; 95% CI 0.31-0.75; P=0.001) provided the better PFS and OS, respectively. In management of women with FIGO III-V E-EC, combination of complete staging surgery (complete dissection of PLN and PALN is included) and the following paclitaxel-based therapy could provide the better chance to survive. Patients with tumor >1/2 myometrial invasion and histological grade 3 are risky for disease-related mortality. ? 2016 Wolters Kluwer Health, Inc. All rights reserved.
SDGs
Other Subjects
paclitaxel; platinum derivative; antineoplastic agent; adjuvant therapy; adult; Article; cancer adjuvant therapy; cancer mortality; cancer prognosis; cancer radiotherapy; cancer staging; cancer surgery; cancer survival; cohort analysis; endometrioid carcinoma; endometrium cancer; female; follow up; human; hysterectomy; lymph node dissection; lymph node metastasis; major clinical study; myometrium; overall survival; para aortic lymph node metastasis; paraaortic lymph node; pelvis cancer; priority journal; progression free survival; retrospective study; salpingooophorectomy; treatment outcome; tumor invasion; uterus surgery; adjuvant chemotherapy; cancer grading; Carcinoma, Endometrioid; Endometrial Neoplasms; lymph node metastasis; middle aged; mortality; pathology; procedures; proportional hazards model; risk factor; survival analysis; Taiwan; Adult; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Endometrioid; Chemotherapy, Adjuvant; Endometrial Neoplasms; Female; Humans; Lymphatic Metastasis; Middle Aged; Neoplasm Grading; Neoplasm Staging; Proportional Hazards Models; Retrospective Studies; Risk Factors; Survival Analysis; Taiwan
Type
journal article