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Survival advantage associated with multimodal therapy in women with node‐positive (stage‐ IIIC ) uterine papillary serous carcinoma: a National Cancer Database study
Author(s) -
Lin JF,
Muñiz K,
Sukumvanich P,
Gehrig P,
Beriwal S,
Kelley JL,
Edwards RP,
Olawaiye AB
Publication year - 2016
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13726
Subject(s) - medicine , stage (stratigraphy) , hazard ratio , endometrial cancer , radiation therapy , cancer , univariate analysis , oncology , serous carcinoma , retrospective cohort study , lymph node , adjuvant therapy , gynecology , confidence interval , multivariate analysis , ovarian cancer , paleontology , biology
Objective Uterine papillary serous carcinoma ( UPSC ) is an aggressive subtype of endometrial cancer. Adjuvant chemotherapy ( CT ) has become standard care in treatment of women with advanced‐stage UPSC , but the role of consolidative radiotherapy ( RT ) is unclear. This study aims to evaluate survival outcomes of multimodal therapy. Design Retrospective cohort study using a National Cancer Database ( NCDB ). Setting United States of America. Sample A total of 1816 women diagnosed with UPSC . Methods All women diagnosed with surgically staged FIGO (International Federation of Gynecology and Obstetrics) stage‐ IIIC UPSC were identified in the NCDB from January 1998 to December 2010. Overall survival ( OS ) was estimated using the Kaplan–Meier method. Univariate and multivariable analyses were performed to identify and control for prognostic factors. Main outcome measure Overall survival. Results A total of 398 057 cases of uterine cancer were identified, 22 106 of which were UPSC . Of these women, 14 093 underwent lymph‐node examination, 2902 (20.6%) were found to have stage‐ IIIC disease, and 1816 received chemotherapy. Younger age and higher number of total lymph nodes examined were independently predictive of receiving multimodality ( CT + RT ) therapy, compared with CT only. Median OS was 33.6 and 42.6 months, for the CT and CT + RT groups, respectively ( P < 0.0005). Exploratory univariate analyses found age, comorbidity index, tumour size, and number of dissected and positive lymph nodes to be also associated with survival. Multivariable analysis controlling for the above found the use of consolidative radiotherapy to be independently predictive of improved OS , with a hazard ratio of 0.69 (95% confidence interval, 95% CI 0.56–0.84). Conclusions Patients with stage‐ IIIC UPSC may benefit from multimodal treatment that includes adjuvant radiotherapy in addition to chemotherapy. Tweetable abstract In this study of 1816 women with uterine papillary serous cancer, adjuvant radiotherapy increased survival.