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Monica Hagan Vetter,Kristin Bixel,Ashley S. Felix 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.6
Objective: The management of stage II endometrial cancer (EC) is challenging due to thewide variation in surgical practice and adjuvant treatment recommendations. We sought todescribe the treatment patterns for patients with stage II EC and to evaluate the associationbetween surgical management and adjuvant therapy on survival outcomes in a large cohort ofpatients with stage II EC. Methods: Using data from the National Cancer Database, we identified 9,690 women withstage II EC. We used logistic regression to identify association of sociodemographic and tumorcharacteristics with surgery type and receipt of adjuvant therapy. We used Cox proportionalhazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs)for associations between adjuvant therapy, hysterectomy type, and overall survival. Results: Almost 11% of the cohort underwent radical hysterectomy; however, there wasno difference in survival between surgical types even when adjusted for adjuvant therapy(HR=0.94; 95% CI=0.82–1.07). Compared to no adjuvant treatment, radiation only(HR=0.66; 95% CI=0.61–0.73) and combination radiation and chemotherapy (HR=0.53;95% CI=0.45–0.62) were associated with lower risk of death. There was no survival benefit ofchemotherapy alone even when separated by histologic subtype (HR range, 0.55–1.46). Conclusions: Women with stage II EC do not appear to benefit from routine radical hysterectomythough all patients appear to benefit from receipt of radiation therapy (RT), regardless ofmodality. Additionally, there may be an added survival benefit with the combination of computedtomography and RT in patients with non-endometrioid, high-risk histologies.
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