Emily M Ko1, Colleen M Brensinger2, Lori Cory3, Robert L Giuntoli4, Ashley F Haggerty5, Nawar A Latif6, Diego Aviles7, Lainie Martin8, Mark A Morgan9, Lilie L Lin10. 1. University of Pennsylvania Health System, Division of Gynecologic Oncology, Philadelphia, PA 19104, United States of America. Electronic address: Emily.ko@pennmedicine.upenn.edu. 2. University of Pennsylvania Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA 19104, United States of America. Electronic address: cbrensin@pennmedicine.upenn.edu. 3. University of Pennsylvania Health System, Division of Gynecologic Oncology, Philadelphia, PA 19104, United States of America. Electronic address: Lory.cory@pennmedicine.upenn.edu. 4. University of Pennsylvania Health System, Division of Gynecologic Oncology, Philadelphia, PA 19104, United States of America. Electronic address: Robert.Giuntoli@pennmedicine.upenn.edu. 5. University of Pennsylvania Health System, Division of Gynecologic Oncology, Philadelphia, PA 19104, United States of America. Electronic address: Ashley.Haggerty@pennmedicine.upenn.edu. 6. University of Pennsylvania Health System, Division of Gynecologic Oncology, Philadelphia, PA 19104, United States of America. Electronic address: Nawar.Latif@uphs.upenn.edu. 7. Pennsylvania Hospital, Department of Obstetrics and Gynecology, Philadelphia, PA 19104, United States of America. Electronic address: Diego.Aviles@pennmedicine.upenn.edu. 8. University of Pennsylvania Health System, Department of Hematology-Oncology, Philadelphia, PA 19104, United States of America. Electronic address: Lainie.Martin@pennmedicine.upenn.edu. 9. University of Pennsylvania Health System, Division of Gynecologic Oncology, Philadelphia, PA 19104, United States of America. Electronic address: Mark.Morgan@pennmedicine.upenn.edu. 10. The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX 77030, United States of America. Electronic address: Lllin@mdanderson.org.
Abstract
OBJECTIVE: To determine the impact on overall survival (OS) of different modalities of adjuvant therapy for the treatment of stage III endometrial cancer (EC), by histology. METHODS: Stage 3 endometrioid (EAC), serous (SER), clear cell (CC), and carcinosarcoma (CS) patients who underwent primary surgical staging from 2000 to 2013 were identified in SEER-Medicare. Adjuvant therapy was defined by a 4-arm comparator grouping (none; RT only; CT only; combination RT), as well as by an 8-arm comparator grouping (none; RT only; CT only; concurrent CT-RT; concurrent CT-RT then CT; Serial CT-RT; serial RT-CT; sandwich). Modality of RT and CT were analyzed using Kaplan-Meier estimates, log rank tests, and multivariable cox modeling. RESULTS: Of 2870 cases identified (1798 EAC, 606 SER, 118 CC, 348 CS), 31.5% received no adjuvant therapy. The remainder received RT or CT alone, concurrent RT-CT, serial or sandwich modalities. OS differed by adjuvant therapy in adjusted and unadjusted models, when combining all histologies, and when stratifying by histology using both the 4-arm, and 8-arm comparator analyses (log rank p < .05, all). By histology, in adjusted analyses, sandwich modality had the greatest improvement in OS for endometrioid, but pairwise comparisons did not identify a superior chemotherapy-based regimen. For serous and clear cell, the greatest improvement in OS was seen with concurrent RT-CT, and for carcinosarcoma, CT alone. CONCLUSIONS: OS for advanced EC significantly differs by histology and mode of adjuvant therapy. Future studies should evaluate the efficacy of combination-based adjuvant therapy versus chemotherapy alone, by histologic subtype and molecular signature.
OBJECTIVE: To determine the impact on overall survival (OS) of different modalities of adjuvant therapy for the treatment of stage III endometrial cancer (EC), by histology. METHODS: Stage 3 endometrioid (EAC), serous (SER), clear cell (CC), and carcinosarcoma (CS) patients who underwent primary surgical staging from 2000 to 2013 were identified in SEER-Medicare. Adjuvant therapy was defined by a 4-arm comparator grouping (none; RT only; CT only; combination RT), as well as by an 8-arm comparator grouping (none; RT only; CT only; concurrent CT-RT; concurrent CT-RT then CT; Serial CT-RT; serial RT-CT; sandwich). Modality of RT and CT were analyzed using Kaplan-Meier estimates, log rank tests, and multivariable cox modeling. RESULTS: Of 2870 cases identified (1798 EAC, 606 SER, 118 CC, 348 CS), 31.5% received no adjuvant therapy. The remainder received RT or CT alone, concurrent RT-CT, serial or sandwich modalities. OS differed by adjuvant therapy in adjusted and unadjusted models, when combining all histologies, and when stratifying by histology using both the 4-arm, and 8-arm comparator analyses (log rank p < .05, all). By histology, in adjusted analyses, sandwich modality had the greatest improvement in OS for endometrioid, but pairwise comparisons did not identify a superior chemotherapy-based regimen. For serous and clear cell, the greatest improvement in OS was seen with concurrent RT-CT, and for carcinosarcoma, CT alone. CONCLUSIONS: OS for advanced EC significantly differs by histology and mode of adjuvant therapy. Future studies should evaluate the efficacy of combination-based adjuvant therapy versus chemotherapy alone, by histologic subtype and molecular signature.
Authors: Daniel H Saris; Anna Jo Bodurtha Smith; Colleen Brensinger; Sarah H Kim; Ashley F Haggerty; Nawar Latif; Lori Cory; Robert L Giuntoli; Mark A Morgan; Lilie L Lin; Emily M Ko Journal: Gynecol Oncol Rep Date: 2022-01-06
Authors: Lori Cory; Colleen Brensinger; Robert A Burger; Robert L Giuntoli; Mark A Morgan; Nawar Latif; Lilie L Lin; Emily M Ko Journal: Gynecol Oncol Rep Date: 2022-01-17