SATEN III—Splitting Adjuvant Treatment of stage III ENdometrial cancers: an international, multicenter study

Abstract

IntroductionThe purposes of this study were to compare adjuvant treatment modalities and to determine prognostic factors in stage III endometrioid endometrial cancer (EC).MethodsSATEN III was a retrospective study involving 13 centers from 10 countries. Patients who had been operated on between 1998 and 2018 and diagnosed with stage III endometrioid EC were analyzed.ResultsA total of 990 women were identified; 317 with stage IIIA, 18 with stage IIIB, and 655 with stage IIIC diseases. The median follow-up was 42 months. The 5-year disease-free survival (DFS) of patients with stage III EC by adjuvant treatment modality was 68.5% for radiotherapy (RT), 54.6% for chemotherapy (CT), and 69.4% for chemoradiation (CRT) (p=0.11). The 5-year overall survival (OS) for those patients was 75.6% for RT, 75% for CT, and 80.7% for CRT (p=0.48). For patients with stage IIIA disease treated by RT versus CT versus CRT, the 5-year OS rates were 75.6%, 75.0%, and 80.7%, respectively (p=0.48). Negative peritoneal cytology (HR: 0.45, 95% CI: 0.23 to 0.86; p=0.02) and performance of lymphadenectomy (HR: 0.33, 95% CI: 0.16 to 0.77, p=0.001) were independent predictors for improved OS for stage IIIA EC. For women with stage IIIC EC treated by RT, CT, and CRT, the 5-year OS rates were 78.9%, 67.0%, and 69.8%, respectively (p=0.08). Independent prognostic factors for better OS for stage IIIC disease were age <60 (HR: 0.50, 95%CI: 0.36 to 0.69, p<0.001), grade 1 or 2 disease (HR: 0.59, 95% CI: 0.37 to 0.94, p=0.014; and HR: 0.65, 95%CI: 0.46 to 0.91, p=0.014, respectively), absence of cervical stromal involvement (HR: 063, 95% CI: 0.46 to 0.86, p=0.004) and performance of para-aortic lymphadenectomy (HR: 0.52, 95% CI: 0.35 to 0.72, p<0.001).DiscussionAlthough not statistically significant, CRT seemed to be a better adjuvant treatment option for stage IIIA endometrioid EC. Systematic lymphadenectomy seemed to improve survival outcomes in stage III endometrioid EC.

Adjuvant chemoradiotherapy versus chemotherapy alone in stage III endometrial cancer: A systematic review and meta‐analysis

“…24 Similar results supporting CRT instead of CT alone in stage III EC were reached by several retrospective studies. 6,7,9,[12][13][14][15][25][26][27] The result of this systematic review and metaanalysis supports the hypothesis above. For both OS and RFS, the pooled HRs significantly recommended CRT as the adjuvant therapy for stage III EC.…”

“…During the study selection process, 15 articles were ultimately enrolled, with 11 adopted in the metaanalysis (10 retrospective studies [6][7][8][9][10][11][12][13][14][15] and 1 RCT 16 ) (Figure 1). The clinical characteristics of the patients and methodological quality of the 11 articles in meta-analysis were summarized in Table 1.…”

“…All studies had a median follow-up period >1 year, mostly >3 years, except for three studies not clearly reporting which. [12][13][14] One retrospective study 9 and the RCT 16 Three studies included did not mention adjuvant chemotherapy regimens detailedly, 10,12,14 which would be excluded in the sensitivity analysis. All the six studies included were of relatively high quality according to the NOS and modified Jadad scale.…”

Perioperative period in the radical treatment of uterine cancer: features of management

“…In recent decades, there has been a significant increase in an increase in the incidence of benign and malignant neoplasms of the uterine body. Since 1997, in Russia, maternal body cancer has taken the first place in the structure of malignant qualitative neoplasms of the female genital organs [1,2,6,14]. In the structure of mortality, oncological problems occupy one of the first places, however less known is that thrombosis appears as the second most frequent cause of death of cancer patients [9,10,11,12,13,14].…”

“…Since 1997, in Russia, maternal body cancer has taken the first place in the structure of malignant qualitative neoplasms of the female genital organs [1,2,6,14]. In the structure of mortality, oncological problems occupy one of the first places, however less known is that thrombosis appears as the second most frequent cause of death of cancer patients [9,10,11,12,13,14]. Modern literature suggests that the activation of the hemostatic system connected with the development of chronic DIC syndrome in cancer patients.…”