Not all stage I and II endometrial cancers are created equal: Recurrence-free survival and cause-specific survival after observation or vaginal brachytherapy alone in all subgroups of early-stage high-intermediate and high-risk endometrial cancer

Simone Garzon, Tommaso Grassi, Andrea Mariani, Swapna Kollikonda, Amy L. Weaver, Michaela E. McGree, Ivy A. Petersen, S. John Weroha, Gretchen E. Glaser, Carrie L. Langstraat, Sudha R. Amarnath, Mariam M. AlHilli

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate recurrence-free survival (RFS) and cause-specific survival (CSS) after observation or vaginal brachytherapy (VB) alone in all subgroups of early-stage high-intermediate (HIR) and high-risk endometrial cancer (EC). Methods: We identified patients with stage I HIR (GOG-249 criteria) and stage II endometrioid EC, and stage I and II non-endometrioid EC who underwent surgery at Mayo Clinic and Cleveland Clinic between 1999 and 2016. Three-year RFS and CSS after observation or VB only were estimated in 16 subgroups defined by risk factors. Results: Among 4156 ECs, we identified 447 (10.8%) stage I endometrioid HIR, 52 (1.3%) stage II endometrioid, 350 (8.4%) stage I non-endometrioid, and 17 (0.4%) stage II non-endometrioid ECs; observation or VB alone was applied in 349 (78.1%), 24 (46.2%), 187 (53.4%), and 2 (11.8%) patients, respectively. After observation or VB, stage I HIR endometrioid EC subgroups with <2 factors among grade 3, LVSI, or stage IB had a 3-year CSS >95% (lower 95% confidence intervals limit: 89.8%), whereas subgroups with ≥2 factors had poorer outcomes. No EC-related deaths after 3 years were reported in 97 stage IA non-endometrioid ECs without myometrial invasion. Stage II ECs had poor outcomes regardless of histology. Conclusions: Observation or VB only may be sufficient in stage I endometrioid HIR ECs with <2 factors among grade 3, LVSI, or IB and in stage IA non-endometrioid ECs without myometrial invasion. Stratification of early-stage HIR and high-risk ECs into risk subgroups potentially alleviates the overtreatment and undertreatment risk and should be considered in future research.

Original languageEnglish (US)
Pages (from-to)444-451
Number of pages8
JournalGynecologic oncology
Volume167
Issue number3
DOIs
StatePublished - Dec 2022

Keywords

  • Adjuvant therapy
  • Early-stage
  • Endometrial cancer
  • High-intermediate risk
  • High-risk
  • Oncologic outcomes

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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