Efficacy of contemporary chemotherapy in stage IIIC endometrial cancer: A histologic dichotomy

Jamie N Bakkum-Gamez, Andrea Mariani, Sean Christopher Dowdy, Amy L. Weaver, Michaela E. McGree, Janice R. Martin, Gary Keeney, Aminah Jatoi, Bobbie S. Gostout, Karl C. Podratz

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background Treatment failures in stage IIIC endometrial carcinoma (EC) are predominantly due to occult extrapelvic metastases (EPM). The impact of chemotherapy on occult EPM was investigated according to grade (G), G1/2EC vs G3EC. Methods All surgical-stage IIIC EC cases from January 1, 1999, through December 31, 2008, from Mayo Clinic were included. Patient-, disease-, and treatment-specific risk factors were assessed for association with overall survival, cause-specific survival, and extrapelvic disease-free survival (DFS) using Cox proportional hazards regression. Results 109 cases met criteria, with 92 (84%) having systematic lymphadenectomy (> 10 pelvic and > 5 paraaortic lymph nodes resected). In patients with documented recurrence sites, occult EPM accounted for 88%. Among G1/2EC cases (n = 48), the sole independent predictor of extrapelvic DFS was grade 2 histology (hazard ratio [HR], 0.28; 95% CI, 0.08-0.91; P =.03) while receipt of adjuvant chemotherapy approached significance (HR 0.13; 95% CI, 0.02, 1.01; P =.0511). The 5-year extrapelvic DFS with and without adjuvant chemotherapy was 93% and 54%, respectively (log-rank, P =.02). Among G3EC (n = 61), the sole independent predictor of extrapelvic DFS was lymphovascular space involvement (HR, 2.63; 95% CI, 1.16-5.97; P =.02). Adjuvant chemotherapy did not affect occult EPM in G3EC; the 5-year extrapelvic DFS for G3EC with and without adjuvant chemotherapy was 43% and 42%, respectively (log-rank, P =.91). Conclusions Chemotherapy improves extrapelvic DFS for stage IIIC G1/2EC but not stage IIIC G3EC. Future efforts should focus on prospectively assessing the impact of chemotherapy on DFS in G3EC and developing innovative phase I and II trials of novel systemic therapies for advanced G3EC.

Original languageEnglish (US)
Pages (from-to)578-584
Number of pages7
JournalGynecologic Oncology
Volume132
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Endometrial Neoplasms
Disease-Free Survival
Drug Therapy
Adjuvant Chemotherapy
Neoplasm Metastasis
Survival
Lymph Node Excision
Treatment Failure
Histology
Lymph Nodes
Recurrence
Therapeutics

Keywords

  • Chemotherapy efficacy
  • Occult extrapelvic metastases
  • Stage IIIC endometrial cancer
  • Survival

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Efficacy of contemporary chemotherapy in stage IIIC endometrial cancer : A histologic dichotomy. / Bakkum-Gamez, Jamie N; Mariani, Andrea; Dowdy, Sean Christopher; Weaver, Amy L.; McGree, Michaela E.; Martin, Janice R.; Keeney, Gary; Jatoi, Aminah; Gostout, Bobbie S.; Podratz, Karl C.

In: Gynecologic Oncology, Vol. 132, No. 3, 2014, p. 578-584.

Research output: Contribution to journalArticle

Bakkum-Gamez, Jamie N ; Mariani, Andrea ; Dowdy, Sean Christopher ; Weaver, Amy L. ; McGree, Michaela E. ; Martin, Janice R. ; Keeney, Gary ; Jatoi, Aminah ; Gostout, Bobbie S. ; Podratz, Karl C. / Efficacy of contemporary chemotherapy in stage IIIC endometrial cancer : A histologic dichotomy. In: Gynecologic Oncology. 2014 ; Vol. 132, No. 3. pp. 578-584.
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abstract = "Background Treatment failures in stage IIIC endometrial carcinoma (EC) are predominantly due to occult extrapelvic metastases (EPM). The impact of chemotherapy on occult EPM was investigated according to grade (G), G1/2EC vs G3EC. Methods All surgical-stage IIIC EC cases from January 1, 1999, through December 31, 2008, from Mayo Clinic were included. Patient-, disease-, and treatment-specific risk factors were assessed for association with overall survival, cause-specific survival, and extrapelvic disease-free survival (DFS) using Cox proportional hazards regression. Results 109 cases met criteria, with 92 (84{\%}) having systematic lymphadenectomy (> 10 pelvic and > 5 paraaortic lymph nodes resected). In patients with documented recurrence sites, occult EPM accounted for 88{\%}. Among G1/2EC cases (n = 48), the sole independent predictor of extrapelvic DFS was grade 2 histology (hazard ratio [HR], 0.28; 95{\%} CI, 0.08-0.91; P =.03) while receipt of adjuvant chemotherapy approached significance (HR 0.13; 95{\%} CI, 0.02, 1.01; P =.0511). The 5-year extrapelvic DFS with and without adjuvant chemotherapy was 93{\%} and 54{\%}, respectively (log-rank, P =.02). Among G3EC (n = 61), the sole independent predictor of extrapelvic DFS was lymphovascular space involvement (HR, 2.63; 95{\%} CI, 1.16-5.97; P =.02). Adjuvant chemotherapy did not affect occult EPM in G3EC; the 5-year extrapelvic DFS for G3EC with and without adjuvant chemotherapy was 43{\%} and 42{\%}, respectively (log-rank, P =.91). Conclusions Chemotherapy improves extrapelvic DFS for stage IIIC G1/2EC but not stage IIIC G3EC. Future efforts should focus on prospectively assessing the impact of chemotherapy on DFS in G3EC and developing innovative phase I and II trials of novel systemic therapies for advanced G3EC.",
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T1 - Efficacy of contemporary chemotherapy in stage IIIC endometrial cancer

T2 - A histologic dichotomy

AU - Bakkum-Gamez, Jamie N

AU - Mariani, Andrea

AU - Dowdy, Sean Christopher

AU - Weaver, Amy L.

AU - McGree, Michaela E.

AU - Martin, Janice R.

AU - Keeney, Gary

AU - Jatoi, Aminah

AU - Gostout, Bobbie S.

AU - Podratz, Karl C.

PY - 2014

Y1 - 2014

N2 - Background Treatment failures in stage IIIC endometrial carcinoma (EC) are predominantly due to occult extrapelvic metastases (EPM). The impact of chemotherapy on occult EPM was investigated according to grade (G), G1/2EC vs G3EC. Methods All surgical-stage IIIC EC cases from January 1, 1999, through December 31, 2008, from Mayo Clinic were included. Patient-, disease-, and treatment-specific risk factors were assessed for association with overall survival, cause-specific survival, and extrapelvic disease-free survival (DFS) using Cox proportional hazards regression. Results 109 cases met criteria, with 92 (84%) having systematic lymphadenectomy (> 10 pelvic and > 5 paraaortic lymph nodes resected). In patients with documented recurrence sites, occult EPM accounted for 88%. Among G1/2EC cases (n = 48), the sole independent predictor of extrapelvic DFS was grade 2 histology (hazard ratio [HR], 0.28; 95% CI, 0.08-0.91; P =.03) while receipt of adjuvant chemotherapy approached significance (HR 0.13; 95% CI, 0.02, 1.01; P =.0511). The 5-year extrapelvic DFS with and without adjuvant chemotherapy was 93% and 54%, respectively (log-rank, P =.02). Among G3EC (n = 61), the sole independent predictor of extrapelvic DFS was lymphovascular space involvement (HR, 2.63; 95% CI, 1.16-5.97; P =.02). Adjuvant chemotherapy did not affect occult EPM in G3EC; the 5-year extrapelvic DFS for G3EC with and without adjuvant chemotherapy was 43% and 42%, respectively (log-rank, P =.91). Conclusions Chemotherapy improves extrapelvic DFS for stage IIIC G1/2EC but not stage IIIC G3EC. Future efforts should focus on prospectively assessing the impact of chemotherapy on DFS in G3EC and developing innovative phase I and II trials of novel systemic therapies for advanced G3EC.

AB - Background Treatment failures in stage IIIC endometrial carcinoma (EC) are predominantly due to occult extrapelvic metastases (EPM). The impact of chemotherapy on occult EPM was investigated according to grade (G), G1/2EC vs G3EC. Methods All surgical-stage IIIC EC cases from January 1, 1999, through December 31, 2008, from Mayo Clinic were included. Patient-, disease-, and treatment-specific risk factors were assessed for association with overall survival, cause-specific survival, and extrapelvic disease-free survival (DFS) using Cox proportional hazards regression. Results 109 cases met criteria, with 92 (84%) having systematic lymphadenectomy (> 10 pelvic and > 5 paraaortic lymph nodes resected). In patients with documented recurrence sites, occult EPM accounted for 88%. Among G1/2EC cases (n = 48), the sole independent predictor of extrapelvic DFS was grade 2 histology (hazard ratio [HR], 0.28; 95% CI, 0.08-0.91; P =.03) while receipt of adjuvant chemotherapy approached significance (HR 0.13; 95% CI, 0.02, 1.01; P =.0511). The 5-year extrapelvic DFS with and without adjuvant chemotherapy was 93% and 54%, respectively (log-rank, P =.02). Among G3EC (n = 61), the sole independent predictor of extrapelvic DFS was lymphovascular space involvement (HR, 2.63; 95% CI, 1.16-5.97; P =.02). Adjuvant chemotherapy did not affect occult EPM in G3EC; the 5-year extrapelvic DFS for G3EC with and without adjuvant chemotherapy was 43% and 42%, respectively (log-rank, P =.91). Conclusions Chemotherapy improves extrapelvic DFS for stage IIIC G1/2EC but not stage IIIC G3EC. Future efforts should focus on prospectively assessing the impact of chemotherapy on DFS in G3EC and developing innovative phase I and II trials of novel systemic therapies for advanced G3EC.

KW - Chemotherapy efficacy

KW - Occult extrapelvic metastases

KW - Stage IIIC endometrial cancer

KW - Survival

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