title: 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).
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.
authors.affiliation: From the Department of Obstetrics and Gynecology, MacKay Memorial Hospital and MacKay Junior College of Medicine, Nursing and Management, Taipei (J-RC); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan (T-CC); Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung (H-CF); Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei (H-YL, P-HW); Department of Obstetrics and Gynecology, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (I-HC), Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung (Y-MK), Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, National Cheng Kung University, Tainan (Y-LL); Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung (A-JC); Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei (C-YH); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C-YH); Department of Obstetrics and Gynecology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung (Y-CC), Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien (M-KH), Department of Obstetrics and Gynecology, Tri-Service General Hospital and National Defense Medical Center (Y-CW); Department of Obstetrics and Gynecology, Chi-Mei Medical Center, Tainan (K-FH); Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City (S-MH); Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei (H-YL, P-HW); and Department of Medical Research, China Medical University Hospital, Taichung (P-HW), Taiwan.
authors.forename: Jen-Ruei
authors.initials: JR
authors.lastname: Chen
authors.forename: Ting-Chang
authors.initials: TC
authors.lastname: Chang
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Fu
authors.forename: Hei-Yu
authors.initials: HY
authors.lastname: Lau
authors.forename: I-Hui
authors.initials: IH
authors.lastname: Chen
authors.forename: Yu-Min
authors.initials: YM
authors.lastname: Ke
authors.forename: Yu-Ling
authors.initials: YL
authors.lastname: Liang
authors.forename: An-Jen
authors.initials: AJ
authors.lastname: Chiang
authors.forename: Chia-Yen
authors.initials: CY
authors.lastname: Huang
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Chen
authors.forename: Mun-Kun
authors.initials: MK
authors.lastname: Hong
authors.forename: Yu-Chi
authors.initials: YC
authors.lastname: Wang
authors.forename: Kuo-Feng
authors.initials: KF
authors.lastname: Huang
authors.forename: Sheng-Mou
authors.initials: SM
authors.lastname: Hsiao
authors.forename: Peng-Hui
authors.initials: PH
authors.lastname: Wang
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018269:Carcinoma, Endometrioid / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan