Amanda N Fader1, James Java2, Meaghan Tenney3, Stephanie Ricci4, Camille C Gunderson5, Sarah M Temkin6, Nick Spirtos7, Christina L Kushnir8, Michael L Pearl9, Oliver Zivanovic10, Krishnansu S Tewari11, David O'Malley12, Ellen M Hartenbach13, Chad A Hamilton14, Natalie S Gould15, Robert S Mannel16, William Rodgers17, Joan L Walker18. 1. Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, United States. Electronic address: afader1@jhmi.edu. 2. NRG Oncology/Gynecologic Oncology Group Statisticsl & Data Center, Roswell Park Cancer Institute, Buffalo, NY, United States. Electronic address: james.j.java@gmail.com. 3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago School of Medicine, Chicago, IL, United States. Electronic address: mtenney@babies.bsd.uchicago.edu. 4. Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, United States. Electronic address: RICCIS@ccf.org. 5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK, United States. Electronic address: camille-gunderson@ouhsc.edu. 6. Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, United States. Electronic address: stemkin1@jhmi.edu. 7. Women's Cancer Center of Nevada, Las Vegas, NV, United States. Electronic address: nspirtos@wccenter.com. 8. Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, United States. Electronic address: christinalkush@gmail.com. 9. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stony Brook University, Stony Brook, NY, United States. Electronic address: michael.pearl@sbumed.org. 10. Division of Gynecologic Oncology, Memorial Sloan-Kettering Cancer Center, New York City, NY, United States. Electronic address: zivanovo@mskcc.org. 11. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Medical Center at Irvine; Orange, CA, United States. Electronic address: ktewari@uci.edu. 12. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ohio State Comprehensive Cancer Center; Columbus, OH, United States. Electronic address: omalley.46@osu.edu. 13. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin Hospital - Madison; Madison, WI, United States. Electronic address: emharten@wisc.edu. 14. Division of Gynecologic Oncology; Walter Reed National Military Medical Center; Bethesda, MD, United States. Electronic address: chad.a.hamilton.mil@health.mil. 15. Women's Cancer Center of Nevada, Las Vegas, NV, United States. Electronic address: ngould@wccenter.com. 16. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK, United States. Electronic address: Robert-Mannel@ouhsc.edu. 17. Department of Pathology; New York Hospital Queens; Flushing, NY, United States. Electronic address: whr9001@nyp.org. 18. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK, United States. Electronic address: joan-walker@ouhsc.edu.
Abstract
OBJECTIVES: We sought to analyze the clinicopathologic features, recurrence patterns and survival outcomes of women with high-grade uterine cancer (UC) enrolled on The Gynecologic Oncology Group (GOG) LAP2 trial. METHODS: This is a post-hoc analysis of LAP-2 patients with grade 3 endometrioid adenocarcinoma (ENDO), uterine serous (USC), clear cell (CC) and carcinosarcoma (CS). Demographics, clinicopathologic features, and recurrence patterns, were compared by histology and surgical approach. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS: Of the 2600 patients enrolled in LAP-2, 753 patients had high-grade UC: 350 had ENDO, 289 had USC, 42 had CC and 72 had CS. Compared with the ENDO cohort, those with other high-grade subtypes were older (p<0.001) and were more likely to have positive peritoneal cytology (p<0.001), positive lymph nodes (p=0.05) and higher disease stage on final pathology (p<0.001). With a median follow-up time of 60months, compared to patients with ENDO, those with USC, CCC and CS subtypes had higher recurrence rates (p<0.001), extra-pelvic recurrences (p<0.001) and poorer PFS (p<0.001) and OS (p<0.001). Those diagnosed with USC and CS experienced the worst survival outcomes (p=0.003). Patterns of recurrence and survival were not different in those staged with LSC vs LAP. On multivariable analysis, age, stage, pelvic washings and Type II histology were independently and adversely associated with survival. CONCLUSIONS: Women with apparent early-stage, USC and CS histologies have poorer outcomes than women with grade 3 endometrioid adenocarcinoma. Patterns of recurrence and survival were not impacted by surgical approach.
OBJECTIVES: We sought to analyze the clinicopathologic features, recurrence patterns and survival outcomes of women with high-grade uterine cancer (UC) enrolled on The Gynecologic Oncology Group (GOG) LAP2 trial. METHODS: This is a post-hoc analysis of LAP-2 patients with grade 3 endometrioid adenocarcinoma (ENDO), uterine serous (USC), clear cell (CC) and carcinosarcoma (CS). Demographics, clinicopathologic features, and recurrence patterns, were compared by histology and surgical approach. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS: Of the 2600 patients enrolled in LAP-2, 753 patients had high-grade UC: 350 had ENDO, 289 had USC, 42 had CC and 72 had CS. Compared with the ENDO cohort, those with other high-grade subtypes were older (p<0.001) and were more likely to have positive peritoneal cytology (p<0.001), positive lymph nodes (p=0.05) and higher disease stage on final pathology (p<0.001). With a median follow-up time of 60months, compared to patients with ENDO, those with USC, CCC and CS subtypes had higher recurrence rates (p<0.001), extra-pelvic recurrences (p<0.001) and poorer PFS (p<0.001) and OS (p<0.001). Those diagnosed with USC and CS experienced the worst survival outcomes (p=0.003). Patterns of recurrence and survival were not different in those staged with LSC vs LAP. On multivariable analysis, age, stage, pelvic washings and Type II histology were independently and adversely associated with survival. CONCLUSIONS: Women with apparent early-stage, USC and CS histologies have poorer outcomes than women with grade 3 endometrioid adenocarcinoma. Patterns of recurrence and survival were not impacted by surgical approach.
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