title: Treatment related outcomes in high-risk endometrial carcinoma: Canadian high risk endometrial cancer consortium (CHREC).
abstract: OBJECTIVE
  The lack of randomized clinical data pertaining to optimal surgery and adjuvant treatment in women with high-risk histotypes of endometrial cancer has resulted in selective management based on institutional policies. The objective of this study was to assess differences in treatment strategies and their outcomes among various institutions.
  
  
  METHODS
  High-risk endometrial cancer cases (2000-2012) with corresponding clinicopathologic data were collected from 7 academic cancer centers. Histotypes included grade 3 endometrioid (EC3), serous (ESC), clear cell (CCC) and carcinosarcoma (CS). Associations with overall survival were performed using Cox proportional hazard regression.
  
  
  RESULTS
  1260 patients treated between 2000 and 2012 were included in the study: 398 EC3, 449 ESC, 91 CCC, 236 CS and 83 'other'. The use of adjuvant chemotherapy, adjuvant radiation, and extent of surgical staging were statistically different among the 7 centers (P<0.001). Histotype was independently associated with overall survival (OS) in patients with stage 1 and 2 disease who underwent surgical staging (P=0.0324). Adjuvant radiation was associated with improved OS for EC3 and CCC and adjuvant chemotherapy was associated with improved OS for ESC and CS. There was a high rate of recurrence (17.8% and 21.4%) in completely staged, stage 1A patients with ESC and CS respectively.
  
  
  CONCLUSIONS
  There exists a wide variation in practice and outcomes for high-risk histotypes of endometrial cancer. The relative impact of adjuvant therapy appears to be histotype dependent and prospective studies examining adjuvant treatment in high-risk histotypes should use caution combining them together.
authors: Division of Gynecologic Oncology, University of Toronto, Canada. Electronic address: Marcus.Bernardini@uhn.ca.
authors: Marcus Q
authors: MQ
authors: Bernardini
authors: Division of Gynecologic Oncology, University of Toronto, Canada.
authors: Lilian T
authors: LT
authors: Gien
authors: Division of Gynecologic Oncology, McGill University, Canada.
authors: Susie
authors: S
authors: Lau
authors: Division of Gynecologic Oncology, University of Manitoba, Canada.
authors: Alon D
authors: AD
authors: Altman
authors: Department of Pathology and Laboratory Medicine, University of British Columbia, Canada.
authors: Blake
authors: B
authors: Gilks
authors: Division of Gynecologic Oncology, University of Toronto, Canada.
authors: Sarah E
authors: SE
authors: Ferguson
authors: Department of Pathology and Laboratory Medicine, University of Calgary, Canada.
authors: Martin
authors: M
authors: Köbel
authors: Division of Gynecologic Oncology, CHUM, Université de Montréal, Canada.
authors: Vanessa
authors: V
authors: Samouëlian
authors: Division of Gynecologic Oncology, University of British Columbia, Canada.
authors: Mina
authors: M
authors: Wesa
authors: Division of Gynecologic Oncology, University of Calgary, Canada.
authors: Anna
authors: A
authors: Cameron
authors: Division of Gynecologic Oncology, University of Calgary, Canada.
authors: Gregg
authors: G
authors: Nelson
authors: Department of Pathology and Laboratory Medicine, University of Toronto, Canada.
authors: Guangming
authors: G
authors: Han
authors: Department of Pathology and Laboratory Medicine, University of Toronto, Canada.
authors: Blaise
authors: B
authors: Clarke
authors: Division of Gynecologic Oncology, University of Toronto, Canada.
authors: T C
authors: TC
authors: Ho
authors: Biostatistics Department, Princess Margaret Cancer Centre, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Canada.
authors: Tony
authors: T
authors: Panzarella
authors: Biostatistics Department, Princess Margaret Cancer Centre, Canada.
authors: Eshetu G
authors: EG
authors: Atenafu
authors: Division of Gynecologic Oncology, University of British Columbia, Canada.
authors: Jessica N
authors: JN
authors: McAlpine
mesh_terms: D000368:Aged; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D016896:Treatment Outcome
keywords: Adjuvant treatment; Endometrial cancer; High risk histology; Serous cancer