J Gynecol Oncol.  2018 Sep;29(5):e76. 10.3802/jgo.2018.29.e76.

Treatment outcomes of patients with stage II pure endometrioid-type endometrial cancer: a Taiwanese Gynecologic Oncology Group (TGOG-2006) retrospective cohort study

Affiliations
  • 1Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
  • 2Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.
  • 3Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linko, Taiwan.
  • 4Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
  • 5Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.
  • 6Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
  • 7Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan.
  • 8Department of Obstetrics and Gynecology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
  • 9Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.
  • 10Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan.
  • 11Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Chi-Mei Medical Center, Tainan, Taiwan.
  • 12Department of Obstetrics and Gynecology, Yuan's General Hospital, Kaohsiung, Taiwan.
  • 13Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
  • 14Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan. msyen@vghtpe.gov.tw

Abstract


OBJECTIVE
Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid endometrial cancer (EEC) is still controversial. Aims of this study were to evaluate survival benefits and adverse effects of different hysterectomies with or without adjuvant radiotherapy (RT), and to identify prognostic factors.
METHODS
The patients at 14 member hospitals of the Taiwanese Gynecologic Oncology Group from 1992 to 2013 were retrospectively investigated. Patients were divided into simple hysterectomy (SH) alone, SH with RT, radical hysterectomy (RH) alone, and RH with RT groups. Endpoints were recurrence-free survival (RFS), overall survival (OS), disease-specific survival (DSS), adverse effects and prognostic factors for survival.
RESULTS
Total of 246 patients were enrolled. The 5-year RFS, OS, DSS and recurrence rates for the entire cohort were 89.5%, 94.3%, 96.2% and 10.2%, respectively. Patients receiving RH had more adverse effects including blood loss (p < 0.001), recurrent urinary tract infections (p = 0.013), and leg lymphedema (p = 0.038). Age over 50-year (HR = 9.2; 95% confidence interval [CI], 1.2-70.9) and grade 3 histology (HR = 7.28; 95% CI, 1.45-36.6) were independent predictors of OS. Grade 3 histology was an independent predictor of RFS (HR = 5.13; 95% CI, 1.38-19.1) and DSS (HR = 5.97; 95% CI, 1.06-58.7). Patients receiving adjuvant RT had lower locoregional recurrence (p = 0.046), but no impact on survival.
CONCLUSION
Different treatment modalities yield similar survival outcomes. Patients receiving SH with RT had lower locoregional recurrent with acceptable morbidity. Age and tumor grading remained significant predictors for survival among patients with FIGO 2009 stage II EEC.

Keyword

Uterine cancer; Endometrioid; General Surgery; Radiotherapy; Survival; Recurrence
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