Efficacy of contemporary chemotherapy in stage IIIC endometrial cancer: A histologic dichotomy |
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Authors: | Jamie N Bakkum-Gamez Andrea Mariani Sean C Dowdy Amy L Weaver Michaela E McGree Janice R Martin Gary L Keeney Aminah Jatoi Bobbie S Gostout Karl C Podratz |
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Institution: | 1. Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA;2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA;3. Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA;4. Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA |
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Abstract: | BackgroundTreatment failures in stage IIIC endometrial carcinoma (EC) are predominantly due to occult extrapelvic metastases (EPM). The impact of chemotherapy on occult EPM was investigated according to grade (G), G1/2EC vs G3EC.MethodsAll surgical-stage IIIC EC cases from January 1, 1999, through December 31, 2008, from Mayo Clinic were included. Patient-, disease-, and treatment-specific risk factors were assessed for association with overall survival, cause-specific survival, and extrapelvic disease-free survival (DFS) using Cox proportional hazards regression.Results109 cases met criteria, with 92 (84%) having systematic lymphadenectomy (> 10 pelvic and > 5 paraaortic lymph nodes resected). In patients with documented recurrence sites, occult EPM accounted for 88%. Among G1/2EC cases (n = 48), the sole independent predictor of extrapelvic DFS was grade 2 histology (hazard ratio HR], 0.28; 95% CI, 0.08–0.91; P = .03) while receipt of adjuvant chemotherapy approached significance (HR 0.13; 95% CI, 0.02, 1.01; P = .0511). The 5-year extrapelvic DFS with and without adjuvant chemotherapy was 93% and 54%, respectively (log-rank, P = .02). Among G3EC (n = 61), the sole independent predictor of extrapelvic DFS was lymphovascular space involvement (HR, 2.63; 95% CI, 1.16–5.97; P = .02). Adjuvant chemotherapy did not affect occult EPM in G3EC; the 5-year extrapelvic DFS for G3EC with and without adjuvant chemotherapy was 43% and 42%, respectively (log-rank, P = .91).ConclusionsChemotherapy improves extrapelvic DFS for stage IIIC G1/2EC but not stage IIIC G3EC. Future efforts should focus on prospectively assessing the impact of chemotherapy on DFS in G3EC and developing innovative phase I and II trials of novel systemic therapies for advanced G3EC. |
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Keywords: | CI confidence interval CSS cause-specific survival DFS disease-free survival EBRT external-beam radiotherapy EC endometrial carcinoma FIGO International Federation of Gynecology and Obstetrics G1/2EC FIGO grade 1 and 2 endometrioid endometrial carcinoma G3EC FIGO grade 3 endometrial carcinoma GOG Gynecologic Oncology Group HR hazard ratio LND lymphadenectomy OS overall survival PORTEC Post Operative Radiation Therapy in Endometrial Carcinoma |
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