title: Patterns of Care, Predictors, and Outcomes of Adjuvant Therapy for Early- and Advanced-Stage Uterine Clear Cell Carcinoma: A Population-Based Analysis.
abstract: OBJECTIVE
  The aim of the study was to examine the patterns of care and the impact of chemotherapy and radiation on survival in women diagnosed with uterine clear cell carcinoma (UCCC). The primary outcomes of this analysis were receipt of treatment within 6 months of diagnosis and overall survival.
  
  
  METHODS
  Women diagnosed with UCCC from 2003 to 2011 were identified through the National Cancer Data Base. Standard univariate and multivariable analyses with logistic regression were performed. Kaplan-Meier survival analysis was used to generate overall survival data. Factors predictive of outcome were evaluated using the log-rank test and Cox proportional hazards model.
  
  
  RESULTS
  A total of 3212 patients were identified. Chemotherapy, radiation, and combination chemotherapy and radiation were administered in 23.3%, 19.7%, and 11.1% of women, respectively. After adjusting for age, race, socioeconomic status, facility type, stage, surgery, lymph node dissection, comorbidity index, period of diagnosis, and registry location, there was an association between combined chemotherapy and radiation (hazard ratio, 0.74; 95% confidence interval, 0.61-0.90) with improved survival. Adjuvant therapy was not associated with improved survival among patients with early-stage disease (stages I and II). Both chemotherapy and combined chemotherapy and radiation were associated with significantly improved survival among patients with advanced-stage disease (stages III and IV).
  
  
  CONCLUSIONS
  In patients with early-stage UCCC, adjuvant therapy was not associated with significantly improved survival. Chemotherapy and combination of chemotherapy and radiation were associated with improved survival in patients with advanced-stage UCCC.
authors.affiliation: *Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; and †Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M D Anderson Cancer Center, Houston, TX.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Gockley
authors.forename: J Alejandro
authors.initials: JA
authors.lastname: Rauh-Hain
authors.forename: Amber M
authors.initials: AM
authors.lastname: Anders
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Meyer
authors.forename: Joel
authors.initials: J
authors.lastname: Clemmer
authors.forename: Karen H
authors.initials: KH
authors.lastname: Lu
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Clark
authors.forename: John O
authors.initials: JO
authors.lastname: Schorge
authors.forename: Marcela G
authors.initials: MG
authors.lastname: del Carmen
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000401:mortality*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011379:Prognosis; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy