Ashley S Felix1, D Scott McMeekin2, David Mutch3, Joan L Walker2, William T Creasman4, David E Cohn5, Shamshad Ali6, Richard G Moore7, Levi S Downs8, Olga B Ioffe9, Kay J Park10, Mark E Sherman11, Louise A Brinton12. 1. Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. Electronic address: Felix.20@osu.edu. 2. Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA. 3. Washington University School of Medicine, St. Louis, MO, USA. 4. Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA. 5. Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, USA. 6. NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA. 7. Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital/Brown University, Providence, RI, USA. 8. Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA. 9. Anatomical Pathology, University of Maryland, College Park, MD, USA. 10. Surgical Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 11. Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA. 12. Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Abstract
BACKGROUND: Few studies have analyzed relationships between risk factors for endometrial cancer, especially with regard to aggressive (non-endometrioid) histologic subtypes, and prognosis. We examined these relationships in the prospective NRG Oncology/Gynecologic Oncology Group 210 trial. METHODS: Prior to surgery, participants completed a questionnaire assessing risk factors for gynecologic cancers. Pathology data were derived from clinical reports and central review. We used the Fine and Gray subdistribution hazards model to estimate subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations between etiologic factors and cause-specific subhazards in the presence of competing risks. These models were stratified by tumor subtype and adjusted for stage and socioeconomic status indicators. RESULTS: Median follow-up was 60months after enrollment (range: 1day-118months). Among 4609 participants, a total of 854 deaths occurred, of which, 582 deaths were attributed to endometrial carcinoma. Among low-grade endometrioid cases, endometrial carcinoma-specific subhazards were significantly associated with age at diagnosis (HR=1.04, 95% CI=1.01-1.06 per year, P-trend) and BMI (class II obesity vs. normal BMI: HR=2.29, 95% CI=1.06-4.98, P-trend=0.01). Among high-grade endometrioid cases, endometrial carcinoma-specific subhazards were associated with age at diagnosis (HR=1.05, 95% CI=1.02-1.07 per year, P-trend<0.001). Among non-endometrioid cases, endometrial carcinoma-specific subhazards were associated with parity relative to nulliparity among serous (HR=0.55, 95% CI=0.36-0.82) and carcinosarcoma cases (HR=2.01, 95% CI=1.00-4.05). DISCUSSION: Several endometrial carcinoma risk factors are associated with prognosis, which occurs in a tumor-subtype specific context. If confirmed, these results would suggest that factors beyond histopathologic features and stage are related to prognosis. ClinicalTrials.gov Identifier: NCT00340808. Published by Elsevier Inc.
BACKGROUND: Few studies have analyzed relationships between risk factors for endometrial cancer, especially with regard to aggressive (non-endometrioid) histologic subtypes, and prognosis. We examined these relationships in the prospective NRG Oncology/Gynecologic Oncology Group 210 trial. METHODS: Prior to surgery, participants completed a questionnaire assessing risk factors for gynecologic cancers. Pathology data were derived from clinical reports and central review. We used the Fine and Gray subdistribution hazards model to estimate subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations between etiologic factors and cause-specific subhazards in the presence of competing risks. These models were stratified by tumor subtype and adjusted for stage and socioeconomic status indicators. RESULTS: Median follow-up was 60months after enrollment (range: 1day-118months). Among 4609 participants, a total of 854 deaths occurred, of which, 582 deaths were attributed to endometrial carcinoma. Among low-grade endometrioid cases, endometrial carcinoma-specific subhazards were significantly associated with age at diagnosis (HR=1.04, 95% CI=1.01-1.06 per year, P-trend) and BMI (class II obesity vs. normal BMI: HR=2.29, 95% CI=1.06-4.98, P-trend=0.01). Among high-grade endometrioid cases, endometrial carcinoma-specific subhazards were associated with age at diagnosis (HR=1.05, 95% CI=1.02-1.07 per year, P-trend<0.001). Among non-endometrioid cases, endometrial carcinoma-specific subhazards were associated with parity relative to nulliparity among serous (HR=0.55, 95% CI=0.36-0.82) and carcinosarcoma cases (HR=2.01, 95% CI=1.00-4.05). DISCUSSION: Several endometrial carcinoma risk factors are associated with prognosis, which occurs in a tumor-subtype specific context. If confirmed, these results would suggest that factors beyond histopathologic features and stage are related to prognosis. ClinicalTrials.gov Identifier: NCT00340808. Published by Elsevier Inc.
Authors: Emily M Ko; Paige Walter; Leslie Clark; Amanda Jackson; Jason Franasiak; Corey Bolac; Laura Havrilesky; Angeles Alvarez Secord; Dominic T Moore; Paola A Gehrig; Victoria L Bae-Jump Journal: Gynecol Oncol Date: 2014-04 Impact factor: 5.482
Authors: Julie J Ruterbusch; Rouba Ali-Fehmi; Sara H Olson; Shawnita Sealy-Jefferson; Benjamin A Rybicki; Sharon Hensley-Alford; Mohamed A Elshaikh; Arthur R Gaba; Daniel Schultz; Adnan R Munkarah; Michele L Cote Journal: Am J Obstet Gynecol Date: 2014-06-19 Impact factor: 8.661
Authors: Zachary Nicholas; Nan Hu; Jian Ying; Patrick Soisson; Mark Dodson; David K Gaffney Journal: Am J Clin Oncol Date: 2014-04 Impact factor: 2.339
Authors: Mariam M AlHilli; Andrea Mariani; Jamie N Bakkum-Gamez; Sean C Dowdy; Amy L Weaver; Preema P Peethambaram; Gary L Keeney; William A Cliby; Karl C Podratz Journal: Gynecol Oncol Date: 2014-03-29 Impact factor: 5.482
Authors: Aliyah Almomen; Elke A Jarboe; Mark K Dodson; C Matthew Peterson; Shawn C Owen; Margit M Janát-Amsbury Journal: Pharm Res Date: 2016-05-31 Impact factor: 4.200
Authors: Lauren McVicker; Christopher R Cardwell; Lauren Edge; W Glenn McCluggage; Declan Quinn; James Wylie; Úna C McMenamin Journal: BMC Cancer Date: 2022-04-20 Impact factor: 4.638