TY - JOUR
T1 - Impact of histology and surgical approach on survival among women with early-stage, high-grade uterine cancer
T2 - An NRG Oncology/Gynecologic Oncology Group ancillary analysis
AU - Fader, Amanda N.
AU - Java, James
AU - Tenney, Meaghan
AU - Ricci, Stephanie
AU - Gunderson, Camille C.
AU - Temkin, Sarah M.
AU - Spirtos, Nick
AU - Kushnir, Christina L.
AU - Pearl, Michael L.
AU - Zivanovic, Oliver
AU - Tewari, Krishnansu S.
AU - O'Malley, David
AU - Hartenbach, Ellen M.
AU - Hamilton, Chad A.
AU - Gould, Natalie S.
AU - Mannel, Robert S.
AU - Rodgers, William
AU - Walker, Joan L.
N1 - Funding Information:
This study was supported by National Cancer Institute grants to the University of Oklahoma ( 1CA65221 ), the Gynecologic Oncology Group (GOG) Administrative Office ( CA 27469 ), the Gynecologic Oncology Group Statistical Office ( CA 37517 ), NRG Oncology ( 1U10 CA180822 ) and NRG Operations ( U10CA180868 ). The following Gynecologic Oncology Group (GOG) institutions participated in the GOG 2222 (LAP2) study: Abington Memorial Hospital, Walter Reed Army Medical Center, University of Minnesota Medical School, University of Mississippi Medical Center, University of Pennsylvania Cancer Center, University of California at San Diego, University of Iowa Hospitals and Clinics, University of Texas Southwestern Medical Center at Dallas, Indiana University School of Medicine, University of California Medical Center at Irvine, Tufts–New England Medical Center, Rush–Presbyterian–St Luke's Medical Center, University of New Mexico, The Cleveland Clinic Foundation, State University of New York at Stony Brook, Washington University School of Medicine, Memorial Sloan-Kettering Cancer Center, Columbus Cancer Council, MD Anderson Cancer Center, University of Massachusetts Medical School, Women's Cancer Center, University of Oklahoma, Tacoma General Hospital, Tampa Bay Cancer Consortium, Gynecologic Oncology Network, Fletcher Allen Health Care, University of Wisconsin Hospital, Women and Infants Hospital, and Community Clinical Oncology Program.
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016
Y1 - 2016
N2 - Objectives We sought to analyze the clinicopathologic features, recurrence patterns and survival outcomes of women with high-grade uterine cancer (UC) enrolled on The Gynecologic Oncology Group (GOG) LAP2 trial. Methods This is a post-hoc analysis of LAP-2 patients with grade 3 endometrioid adenocarcinoma (ENDO), uterine serous (USC), clear cell (CC) and carcinosarcoma (CS). Demographics, clinicopathologic features, and recurrence patterns, were compared by histology and surgical approach. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Results Of the 2600 patients enrolled in LAP-2, 753 patients had high-grade UC: 350 had ENDO, 289 had USC, 42 had CC and 72 had CS. Compared with the ENDO cohort, those with other high-grade subtypes were older (p < 0.001) and were more likely to have positive peritoneal cytology (p < 0.001), positive lymph nodes (p = 0.05) and higher disease stage on final pathology (p < 0.001). With a median follow-up time of 60 months, compared to patients with ENDO, those with USC, CCC and CS subtypes had higher recurrence rates (p < 0.001), extra-pelvic recurrences (p < 0.001) and poorer PFS (p < 0.001) and OS (p < 0.001). Those diagnosed with USC and CS experienced the worst survival outcomes (p = 0.003). Patterns of recurrence and survival were not different in those staged with LSC vs LAP. On multivariable analysis, age, stage, pelvic washings and Type II histology were independently and adversely associated with survival. Conclusions Women with apparent early-stage, USC and CS histologies have poorer outcomes than women with grade 3 endometrioid adenocarcinoma. Patterns of recurrence and survival were not impacted by surgical approach.
AB - Objectives We sought to analyze the clinicopathologic features, recurrence patterns and survival outcomes of women with high-grade uterine cancer (UC) enrolled on The Gynecologic Oncology Group (GOG) LAP2 trial. Methods This is a post-hoc analysis of LAP-2 patients with grade 3 endometrioid adenocarcinoma (ENDO), uterine serous (USC), clear cell (CC) and carcinosarcoma (CS). Demographics, clinicopathologic features, and recurrence patterns, were compared by histology and surgical approach. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Results Of the 2600 patients enrolled in LAP-2, 753 patients had high-grade UC: 350 had ENDO, 289 had USC, 42 had CC and 72 had CS. Compared with the ENDO cohort, those with other high-grade subtypes were older (p < 0.001) and were more likely to have positive peritoneal cytology (p < 0.001), positive lymph nodes (p = 0.05) and higher disease stage on final pathology (p < 0.001). With a median follow-up time of 60 months, compared to patients with ENDO, those with USC, CCC and CS subtypes had higher recurrence rates (p < 0.001), extra-pelvic recurrences (p < 0.001) and poorer PFS (p < 0.001) and OS (p < 0.001). Those diagnosed with USC and CS experienced the worst survival outcomes (p = 0.003). Patterns of recurrence and survival were not different in those staged with LSC vs LAP. On multivariable analysis, age, stage, pelvic washings and Type II histology were independently and adversely associated with survival. Conclusions Women with apparent early-stage, USC and CS histologies have poorer outcomes than women with grade 3 endometrioid adenocarcinoma. Patterns of recurrence and survival were not impacted by surgical approach.
KW - High-grade uterine cancer
KW - LAP-2 trial
KW - Minimally invasive surgery
KW - Type II uterine cancer
KW - Uterine cancer
UR - http://www.scopus.com/inward/record.url?scp=84997822679&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84997822679&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2016.10.016
DO - 10.1016/j.ygyno.2016.10.016
M3 - Article
C2 - 27743738
AN - SCOPUS:84997822679
SN - 0090-8258
VL - 143
SP - 460
EP - 465
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 3
ER -