Adjuvant radiotherapy shows benefit in selected stage I uterine sarcoma: A risk scoring system based on a population analysis

Abstract

Background:The potential therapeutic benefit of adjuvant radiotherapy for patients with stage I uterine sarcoma has not been clear. In this study, we aimed to develop a risk scoring model to select the subgroup of patients with stage I uterine sarcoma who might benefit from adjuvant radiotherapy. Methods: Patients with stage I uterine sarcoma from the Surveillance, Epidemiology, and End Results program from 2010 to 2014 were retrospectively included in this analysis. Cox proportional hazards models were performed to identify risk factors. Results: A total of 947 stage I uterine sarcoma patients were included. The 5-year disease-specific survival (DSS) of the overall cohort was 75.81%. Multivariate analysis identified stage (p = 0.013), tumor grade (p <0.001) and histology (p = 0.043)as independent prognostic factors for DSS, and these factors were used to generate the risk scoring model. The low-risk group presented a better DSS than the high-risk group (95.51% vs. 49.88%, p < 0.001). The addition of radiotherapy to surgery significantly increased the DSS in the high-risk group compared with surgery alone (78.06% vs. 46.88%, p = 0.022), but no significant survival benefit was observed in the low-risk group (98.36% vs. 100%, p = 0.766). Conclusions: Our risk scoring model based on stage, tumor grade, and histology predicted the outcome of patients with stage I uterine sarcoma cancer. This system may help to select stage I uterine sarcoma cancer patients who might benefit from adjuvant radiotherapy.

The Prognostic Benefit of Early Postoperative Radiotherapy and Diagnostic Value of Serologic Markers on Women with Uterine Sarcoma and Carcinosarcoma

“…Adjuvant oncologic regimens vary broadly with little consensus on the benefits of the addition of adjuvant radiotherapy (RT) or chemotherapy to optimize oncologic outcome and the application of systemic therapy regimens for improvement of the diseasefree survival remains controversial [11][12][13][14]. The same debate is ongoing about postoperative radiotherapy: Prior studies showed a significant reduction in the risk of locoregional failure with superior 5-year local control (LC) rates of 87% and 5-year diseasespecific survival after adjuvant RT as well as superior overall survival (OS) rates for uterine carcinosarcoma [15][16][17][18][19]. Further, brachytherapy (BT) added therapeutic value to the treatment of uterine sarcoma as it allows for better sparing of the surrounding tissue while maintaining high doses with conformal applicators and improving LC efficiently for 5-year rates of up to 91% [20].…”