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Outcomes of Patients With Surgically and Pathologically Staged IIIA-IVB Pure Endometrioid-type Endometrial Cancer: A Taiwanese Gynecology Oncology Group (TGOG-2005) Retrospective Cohort Study (A STROBE-Compliant Article).
- Source :
-
Medicine [Medicine (Baltimore)] 2016 Apr; Vol. 95 (15), pp. e3330. - Publication Year :
- 2016
-
Abstract
- In the management of patients with advanced-stage pure endometrioid-type endometrial cancer (E-EC), such as positive lymph nodes (stage III) or stage IV, treatment options are severely limited. This article aims to investigate the outcome of women with FIGO III-IV E-EC (based on FIGO 2009 system). The retrospective cohort study, based on the Taiwanese Gynecologic Oncology Group (TGOG-2005), enrolled patients undergoing staging surgery to have a pathologically confirmed FIGO III-IV E-EC from 22-member hospitals between 1991 and 2010. This cohort included 541 patients (stage III, n = 464; stage IV, n = 77). Five-year overall survival (OS) was 70.4%. Median progression-free survival (PFS) was 43 months (range 0-258 months) and median OS was 52 months (range 1-258 months). Multivariate analysis showed that FIGO stage, >1/2 myometrial invasion (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.12-2.09; P = 0.007), histological grade 3 (HR 2.0, 95% CI 1.47-2.75; P < 0.001), and metastases of pelvic and para-aortic lymph nodes (PLN and PALN) (HR 2.75, 95% CI 1.13-6.72; P < 0.001) were independent risk factors for PFS. FIGO stage, >1/2 myometrial invasion (HR 1.89, 95% CI 1.34-2.64; P < 0.001), and histological grade 3 (HR 2.42, 95% CI 1.75-3.35; P < 0.001) influenced OS. Complete dissection of PLN and PALN (HR 0.27, 95% CI 0.16-0.45; P < 0.001, and HR 0.14, 95% CI 0.08-0.26; P < 0.001) and the following paclitaxel-based therapy (HR 0.61, 95% CI 0.79-0.92; P = 0.017, and HR 0.48; 95% CI 0.31-0.75; P = 0.001) provided the better PFS and OS, respectively. In management of women with FIGO III-V E-EC, combination of complete staging surgery (complete dissection of PLN and PALN is included) and the following paclitaxel-based therapy could provide the better chance to survive. Patients with tumor >1/2 myometrial invasion and histological grade 3 are risky for disease-related mortality.
- Subjects :
- Adult
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Carcinoma, Endometrioid drug therapy
Carcinoma, Endometrioid mortality
Chemotherapy, Adjuvant methods
Endometrial Neoplasms drug therapy
Endometrial Neoplasms mortality
Female
Humans
Lymphatic Metastasis
Middle Aged
Neoplasm Grading
Neoplasm Staging
Proportional Hazards Models
Retrospective Studies
Risk Factors
Survival Analysis
Taiwan
Carcinoma, Endometrioid pathology
Carcinoma, Endometrioid surgery
Endometrial Neoplasms pathology
Endometrial Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1536-5964
- Volume :
- 95
- Issue :
- 15
- Database :
- MEDLINE
- Journal :
- Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 27082583
- Full Text :
- https://doi.org/10.1097/MD.0000000000003330