title: Characteristics and prognosis of patients with early-stage endometrial cancer who refuse adjuvant radiotherapy.
abstract: To investigate the risk factors for refusing adjuvant radiotherapy in patients who have undergone surgery for early-stage endometrial cancer, and to compare their survival rates with patients who have undergone adjuvant radiotherapy.
  
  
  
  Data from the Surveillance, Epidemiology, and End Results database for patients operated on for histologically-proven early-stage endometrioid endometrial cancer, between 1988 and 2012, were screened. Univariate and multivariate logistic regression analyses tested the associations between refusal of adjuvant radiotherapy and demographic, tumoral, and management characteristics. Overall and cancer-related survival rates were compared between 376 patients who refused adjuvant radiotherapy and 752 patients who received adjuvant radiotherapy, matched for demographics (age, race, year of diagnosis, marital status, region), tumoral (grade, FIGO stage, size), and management (lymphadenectomy performed) criteria.
  
  
  
  434 of the 16,014 patients (2.7%) who were proposed adjuvant radiotherapy refused this treatment. Older, widowed, divorced, or separated patients, who were recently diagnosed and managed in the Northern plains or Pacific coast (USA), with limited tumoral extension, were more likely to refuse adjuvant radiotherapy. Five-year cancer-related survival was significantly lower in patients who refused adjuvant radiotherapy (88.9% vs. 95.7%, p<0.001) whereas overall survival did not significantly differ between the two groups (76.4% vs. 83.7%, p=0.23).
  
  
  
  We have identified the patients' characteristics related to refusal of adjuvant radiotherapy. Refusing adjuvant radiotherapy increased cancer-related death but probably does not reduce overall survival.
authors.affiliation: Gynecologic Oncology, Bichat University Hospital, Paris Diderot University, Paris, France; EA7285, UVSQ, Montigny-le-Bretonneux, France; Gynecologic Oncology, University Hospitals Leuven, and Department of Oncology, KU Leuven, Leuven, Belgium. Electronic address: martin.koskas@wanadoo.fr.
authors.forename: Martin
authors.initials: M
authors.lastname: Koskas
authors.affiliation: EA7285, UVSQ, Montigny-le-Bretonneux, France; Department of Gynecology and Obstetrics, Poissy-St-Germain Hospital, Poissy, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Huchon
authors.affiliation: Gynecologic Oncology, University Hospitals Leuven, and Department of Oncology, KU Leuven, Leuven, Belgium; Centre for Gynecologic Oncology Amsterdam (CGOA), Antoni Van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Frederic
authors.initials: F
authors.lastname: Amant
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000523:psychology; D045808:Refusal to Participate / Q000523:psychology / Q000706:statistics & numerical data*; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Adjuvant radiotherapy; Endometrial cancer; Refusal; Risk factors; Survival