Survival Analysis of Endometrial Cancer Patients With Positive Lymph Nodes

Brown, Aaron P. MD*; Gaffney, David K. MD, PhD; Dodson, Mark K. MD‡§; Soisson, A. Pat MD‡§; Belnap, Thomas W. MS; Alleman, Kerry BS; Sause, William T. MD

International Journal of Gynecological Cancer: June 2013 - Volume 23 - Issue 5 - p 861–868
doi: 10.1097/IGC.0b013e3182915c3e
Uterine Cancer

Objective: Patients with endometrial cancer with positive lymph nodes (International Federation of Gynecology and Obstetrics stage IIIC) have a substantially worse prognosis. This study investigates how tumor characteristics and adjuvant treatments influence overall survival (OS) in stage IIIC patients.

Methods: This multi-institution, institutional review board–approved study is a retrospective review of 116 patients with surgically staged endometrial cancer with positive lymph nodes treated from 1995 to 2008. The study cohort was evaluated using Kaplan-Meier estimates of OS and proportional hazard modeling.

Results: The 5-year OS for all patients was 51%. Administration of adjuvant therapy was associated with improved OS when compared with surgery alone (P = 0.007). Five-year OS was 40% for patients treated with surgery alone (n = 26), 50% with surgery and chemotherapy (n = 8), 58% with surgery and radiotherapy (n = 43), and 54% with surgery followed by both radiotherapy and chemotherapy (n = 39). Patients who received radiotherapy (n = 82) had improved OS (57%) when compared with patients who did not (n = 34, OS = 42%; P = 0.001). Radiotherapy was associated with improved OS for patients with endometrioid histology, high-grade tumors, and positive para-aortic lymph nodes. Patients with nonendometrioid histology and low-grade tumors who received radiotherapy had a similar OS as those who did not. High-grade tumors (P < 0.001), nonendometrioid histology (P = 0.004), and more than 2 positive lymph nodes (P = 0.01) were associated with a poorer OS. After controlling for patient demographics and tumor characteristics, patients with high-grade tumors and more than 2 positive lymph nodes had a poorer OS, whereas patients who received radiotherapy had improved OS.

Conclusions: This large institutional study of patients with lymph node–positive endometrial cancer identified prognostic factors associated with a poor OS. Radiotherapy was associated with improved survival and may be specifically indicated for patients with endometrioid histology, high-grade tumors, and positive para-aortic lymph nodes. We recommend further investigation of adjuvant therapies in randomized clinical trials.

*Radiation Oncology, MD Anderson Cancer Center, Houston, TX; and †Radiation Oncology, and ‡Gynecological Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City; and §Gynecological Oncology, Intermountain Medical Center, Murray, and ∥Radiation Oncology, UT.

Address correspondence and reprint requests to William T. Sause, MD, Radiation Therapy, Intermountain Medical Center, 5131 S Cottonwood St, Murray, UT 84107. E-mail: william.sause@imail.org.

Some of the data reported in this article were presented at the ASTRO 2010 Annual Meeting, San Diego, CA, on October 31, 2010.

The authors declare no conflicts of interest.

Received January 10, 2013

Accepted March 9, 2013

Copyright © 2013 by IGCS and ESGO