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

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

doi:10.1016/j.ygyno.2022.10.004

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…The modern approach to the treatment of gynecological malignancies foresees the implementation of precise indications for the application of adjuvant therapy, considering the expected long survival of patients in the initial FIGO IA stage of endometrial cancer and over-treatment risk. Previously conducted clinical studies suggest that adjuvant vaginal brachytherapy in early stages of endometrial cancer in a low-risk group does not significantly affect long-term control of the disease [26]. There are studies, in which adjuvant radiotherapy in FIGO stage I endometrial cancer patients was found to improve loco-regional disease control, but without affecting OS [18,20,27] (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…The results of a recent retrospective non-randomized interventional study, which included 419 patients with FIGO stage IA, IB, and II endometrial cancer, suggest that patients with FIGO stage IA disease have the greatest benefit from the adjuvant treatment [22]. A study by Garzon et al that integrated 4,156 FIGO IA endometrial cancer patients showed the non-exceptional effectiveness of vaginal brachytherapy in the medium-high risk group with less than two risk factors (grade 3, presence of lymphovascular invasion or non-endometrioid histology, without invasion of the myometrium) [26]. Additionally, results of a research by Jin et al that included 238 high-and intermediate-risk patients (according to the ESMO-ESGO-ESTRO criteria) with FIGO stage I and II endometrial cancer, showed that the application of brachytherapy, as opposed to brachytherapy with EBRT, is a safe option in terms of disease control and manifestations of radiation toxicity [30].…”

Section: Discussionmentioning

confidence: 99%

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Five-year disease-free survival in FIGO IA stage endometrial cancer patients: Tertiary institution experience in a developing country

Radojević,

Mujković,

Zoran

et al. 2023

jcb

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Purpose: Endometrial cancer is characterized as histopathological, molecular, genetic, biological, and very diverse group of malignancies. Due to the need to precisely define the indications for adjuvant treatment in recent years, there has been a division made according to risk groups based on prognostic factors, which identify patients at risk for disease relapse, who may benefit from adjuvant therapy. The aim of this research was to examine the clinical and morphological factors that influence disease-free survival (DFS) and overall survival (OS) in patients with FIGO IA stage endometrial cancer.Material and methods: A retrospective clinical study was conducted, primarily based on the identification of factors that influence five-year DFS and OS. The study integrated data of FIGO IA stage endometrial cancer patients, who presented to gynecological oncology board for the first time after operative treatment, from January 1, 2016 to January 1, 2022. Adjuvant radiotherapy was applied to patients with an initially higher risk of disease progression. Length of survival was analyzed using Kaplan-Meier method, while log-rank test was used to assess differences between groups.Results: The results show that 5-year OS for 93 patients was 89.2% and DFS was 88.2%. Application of adjuvant brachytherapy, number of deliveries, MRI staging, type of institution where the surgery was performed influenced DFS. Pathohistological characteristics of tumor indicated a statistically significant impact on DFS.Conclusions: Application of adjuvant brachytherapy in high-intermediate and high-risk patients contributes to DFS increase. Moreover, the existence of a pre-operative MRI assessment of the stage of disease as well as the type of healthcare provided by an institution where the surgery was performed, significantly affect DFS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Five-year disease-free survival in FIGO IA stage endometrial cancer patients: Tertiary institution experience in a developing country

Radojević,

Mujković,

Zoran

et al. 2023

jcb

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“…Even with active treatment, the 5-year survival rate of patients with recurrence and metastasis is 17%. There is an urgent need to provide treatment options that produce better outcomes [19,20] . The role of immunotherapy in the treatment of EC is increasing as research into the mechanisms of tumor immunity continues to progress [21,22] .…”

Section: Discussionmentioning

confidence: 99%

High expression of CXCL9 gene promotes immune invasion and improves the prognosis of patients with endometrial cancer

Zhang¹,

Zhang

et al. 2023

Preprint

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Objective: CXCL9 plays a key role in immune cell chemotaxis and inhibition of tumor angiogenesis. The aim of this study was to investigate the prognostic value of CXCL9 in endometrial cancer (EC) and the impact on the immune microenvironment. Methods：RNA sequencing data for EC patients were obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases, while clinicopathological information for EC patients was obtained from the TCGA database. Cox univariate and multivariate analyses were used, followed by the construction and validation of nomograms. CXCL9 expression and survival analysis, gene correlation and immune infiltration correlation analysis, and pathway enrichment analysis were performed using UALCAN, Kaplan-Meier, GeneMANIA, STRING, TIMER, cBioPortal, muTarget, CIBERSORT, TISIDB, GO, KEGG and GSEA tools. Results：CXCL9 was significantly upregulated in EC. Cox univariate and multivariate analysis showed that CXCL9 was an independent predictor of overall survival (OS), disease specific survival (DSS) and progression free interval (PFI) (P<0.05). However, increased CXCL9 expression predicted prolonged OS, DSS and PFI (P<0.05). In addition, CXCL9 was positively correlated with immune cell infiltration and correlated with marker genes of multiple immune pathways as well as marker genes of immune checkpoints. GSEA enrichment analysis suggests that high CXCL9 expression plays an important role in immune cell migration, activation and other functions. Conclusion: The results of this study suggest that high CXCL9 expression was a predictor of good prognosis in patients with EC and may be associated with the recruitment of immune cells to the tumor microenvironment in the tumor tissue to function as an anti-tumor immune response.

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“…Whether adjuvant therapy should be administered after surgery for early endometrial cancer is still controversial. NCCN guidelines recommend that complementary radiotherapy or systemic therapy be considered if patients have potential high-risk factors, including age ≥60 years, deep myometrial invasion, and/or LVSI [14]. Patients with focal or substantial LVSI received diferent adjuvant treatments according to a three-tiered system that quantitates LVSI.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Adjuvant Treatment in Women with Stage I Endometrial Cancer: A Retrospective Study

Sun

Zhou

et al. 2023

International Journal of Clinical Practice

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Objective. To evaluate whether postoperative adjuvant treatment is beneficial for patient survival after surgery for early stage endometrial cancer (EC). We analyzed the outcomes of patients treated with radiotherapy, chemotherapy, or progestagen combined with other adjuvant treatments. Methods. We analyzed the outcomes of patients treated with radiotherapy alone, chemotherapy alone, or progestagen treatment with other adjuvant treatments. Women without any adjuvant treatment after operation were used as controls. We retrospectively examined disease-free survival (DFS), overall survival (OS), and high-risk factors that affected the survival status of all patients who received different postoperative adjuvant therapies. Results. In all 192 patients, the total relapse and mortality rates were 5.57% and 1.68%, respectively. Fourteen patients (7.29%) developed isolated local recurrence, and 2 patients died (1.04%) of recurrence during the follow-up period. The 5-year DFS and OS rates of all patients were 95.83% and 93.75%, respectively. No significant differences were observed in the 5-year DFS, 5-year OS, OS, or DFS among the four groups of patients with FIGO stage I endometrial cancer ( P = 0.9849 , 0.7430, 0.9754, and 0.4534, respectively). The differences in the log-rank test results of the estimates of the 5-year DFS, 5-year OS, DFS, and OS of patients with different disease stages and different ages were all significant, but no differences were observed in these parameters among patients with varying degrees of differentiation. Histologic grade, CA125 level, ER and PR status, and adjuvant therapy had no significant effect on the DFS and OS of all patients according to univariate and multivariate regression analyses, but a significant effect on DFS and OS was found when the patients were stratified by age. Conclusion. This retrospective study showed that adjuvant therapy after surgery was not significantly associated with improved DFS or OS in patients with early stage endometrial cancer. However, FIGO stage and age affected the survival of patients with stage I endometrial cancer.

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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

Cited by 8 publications

References 26 publications

Five-year disease-free survival in FIGO IA stage endometrial cancer patients: Tertiary institution experience in a developing country

Five-year disease-free survival in FIGO IA stage endometrial cancer patients: Tertiary institution experience in a developing country

High expression of CXCL9 gene promotes immune invasion and improves the prognosis of patients with endometrial cancer

Postoperative Adjuvant Treatment in Women with Stage I Endometrial Cancer: A Retrospective Study

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