Janice S Kwon1, Feng Qiu, Refik Saskin, Mark S Carey. 1. From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; and the Department of Programming and Biostatistics, Institute for Clinical Evaluative Sciences, Toronto, Canada.
Abstract
OBJECTIVE: To evaluate factors associated with survival after lymphadenectomy for endometrial cancer and to address their effect relating to systemic therapy. METHODS: This was a retrospective, population-based cohort study of 316 women with endometrial cancer who underwent surgery including lymphadenectomy in Ontario, Canada, from 1996-2000. Data obtained from administrative databases included comorbidities, socioeconomic status, grade, myometrial invasion, cervical involvement, lymphovascular-space invasion, nodal status, and adjuvant pelvic radiotherapy. Primary outcome was 5-year overall survival. Factors associated with survival were identified in a multivariable Cox proportional hazards model. RESULTS: Mean age was 62.2 years (+/-11.6 years). Thirty-eight women (12%) had positive pelvic nodes. Seventy-five (23.7%) received adjuvant pelvic radiotherapy. Age older than 60, grade 3 tumor, deep myometrial invasion (greater than 50%), and cervical stromal involvement were associated with a higher risk of death compared with reference categories. There were no survival differences according to comorbidities, socioeconomic status, or lymphovascular-space invasion. Five-year overall survival was 53.1% for node-negative patients with two or three uterine risk factors and 75.0% for node-positive patients with none or only one uterine risk factor. Pelvic-node status was not an independent determinant of survival (positive nodes: hazard ratio 1.39, 95% confidence interval 0.89-2.18). CONCLUSION: High-risk uterine factors including grade 3 tumor, deep myometrial invasion, and cervical stromal involvement are more significant determinants of survival in endometrial cancer than pelvic-node status. Uterine risk factors should be considered, regardless of nodal status, when offering systemic therapy to maximize survival outcomes. LEVEL OF EVIDENCE: II.
OBJECTIVE: To evaluate factors associated with survival after lymphadenectomy for endometrial cancer and to address their effect relating to systemic therapy. METHODS: This was a retrospective, population-based cohort study of 316 women with endometrial cancer who underwent surgery including lymphadenectomy in Ontario, Canada, from 1996-2000. Data obtained from administrative databases included comorbidities, socioeconomic status, grade, myometrial invasion, cervical involvement, lymphovascular-space invasion, nodal status, and adjuvant pelvic radiotherapy. Primary outcome was 5-year overall survival. Factors associated with survival were identified in a multivariable Cox proportional hazards model. RESULTS: Mean age was 62.2 years (+/-11.6 years). Thirty-eight women (12%) had positive pelvic nodes. Seventy-five (23.7%) received adjuvant pelvic radiotherapy. Age older than 60, grade 3 tumor, deep myometrial invasion (greater than 50%), and cervical stromal involvement were associated with a higher risk of death compared with reference categories. There were no survival differences according to comorbidities, socioeconomic status, or lymphovascular-space invasion. Five-year overall survival was 53.1% for node-negative patients with two or three uterine risk factors and 75.0% for node-positive patients with none or only one uterine risk factor. Pelvic-node status was not an independent determinant of survival (positive nodes: hazard ratio 1.39, 95% confidence interval 0.89-2.18). CONCLUSION: High-risk uterine factors including grade 3 tumor, deep myometrial invasion, and cervical stromal involvement are more significant determinants of survival in endometrial cancer than pelvic-node status. Uterine risk factors should be considered, regardless of nodal status, when offering systemic therapy to maximize survival outcomes. LEVEL OF EVIDENCE: II.
Authors: Soledad Jorge; June Y Hou; Ana I Tergas; William M Burke; Yongmei Huang; Jim C Hu; Cande V Ananth; Alfred I Neugut; Dawn L Hershman; Jason D Wright Journal: Gynecol Oncol Date: 2016-01-06 Impact factor: 5.482
Authors: A Talhouk; M K McConechy; S Leung; H H Li-Chang; J S Kwon; N Melnyk; W Yang; J Senz; N Boyd; A N Karnezis; D G Huntsman; C B Gilks; J N McAlpine Journal: Br J Cancer Date: 2015-06-30 Impact factor: 7.640
Authors: Nicole C M Visser; Johan Bulten; Anneke A M van der Wurff; Erik A Boss; Carolien M Bronkhorst; Harrie W H Feijen; Joke E Haartsen; Hilde A D M van Herk; Ineke M de Kievit; Paul J J M Klinkhamer; Brenda M Pijlman; Marc P M L Snijders; Ingrid Vandenput; M Caroline Vos; Peter E J de Wit; Lonneke V van de Poll-Franse; Leon F A G Massuger; Johanna M A Pijnenborg Journal: BMC Cancer Date: 2015-06-30 Impact factor: 4.430
Authors: Pluvio J Coronado; Agnieszka Rychlik; Maria A Martínez-Maestre; Laura Baquedano; María Fasero; Aida García-Arreza; Sara Morales; Daniel M Lubian; Ignacio Zapardiel Journal: J Gynecol Oncol Date: 2018-01 Impact factor: 4.401