Management of intermediate-high risk early stage endometrial cancer (EC) can be challenging since a proportion of these patients (pts) relapse and the role of adjuvant chemotherapy (CT) is unclear. We aimed to evaluate the role of adjuvant CT for this population.
This retrospective study evaluated pts with intermediate-high risk early stage EC treated in a single center from 2009 to 2021. Endpoints were overall survival (OS) and disease free survival (DFS) according to the adjuvant systemic treatment used after surgery. The Kaplan-Meier method was used for survival analyses. Hazard ratio (HR) and 95% confidence interval (95% CI) were calculated using Cox regression.
175 pts were evaluated and median age was 63 years (IQR 34-88). About the risk category, 33% had stage I disease with lymphovascular invasion (LVI); 22% had stage IB with grade 3 disease and 43% had stage II disease. Regarding surgery, 144 pts (82%) were submitted to pelvic and 107 (61%) to paraortic lymphadenectomy. 41 pts (29%) received CT (96% carboplatin and paclitaxel), 37 (21%) received adjuvant external beam radiotherapy (EBRT), 37 (21%) received adjuvant brachytherapy (BCT), and 77 (44%) received both EBRT and BCT.
With a median follow-up of 64 months, 33 pts had a disease recurrence; 10% had a locoregional recurrence, 7% a distant recurrence, and 2% had both locoregional and distant recurrence. No difference was observed in DFS or OS according to the use of adjuvant CT. 5-year DFS rates were 74.7% (95% CI 64.7 - 82.2%) in those who received CT and 77% (95% CI 62.3- 86.6%) in pts who did not received CT (p= 0.392). 5-year OS were 87.1% (95% CI 78.2 - 92.5%) in and 93.3% (95% CI 80.6 - 97.8%), respectively (p= 0.259). BCT (HR 0.36, 95% CI 0.18 - 0.68, P=0.002) and pelvic lymphadenectomy (HR 0.42, 95% CI 0.21 - 0.83, P=0.014) were identified as factors associated with a superior DFS, while FIGO stage II (HR 2.17, 95% CI 1.12 - 4.22, P=0.021) was associated with inferior DFS. Pts that received BCT had less locoregional recurrence than those who did not receive it (4,4% vs 10,3%).
Pts with intermediated-high risk early stage EC does not seem to benefit from adjuvant CT. In this cohort, BCT and pelvic lymphadenectomy were associated with a better DFS.