Abstract
Prognostic Impact of Mismatch Repair Deficiency on Stage I-II Endometrioid Endometrial Cancer Treated with Adjuvant Radiation Therapy: A Multi-Institutional Analysis
International journal of radiation oncology, biology, physics, v 117(2), pp S8-S8
01 Oct 2023
Abstract
To report the impact of mismatch repair (MMR) status on outcomes in patients with stage I-II endometrioid endometrial cancer (EEC).
This is a multi-institutional retrospective cohort study across 11 institutions. Preliminary data from 7 centers is available for analysis. Patients with known MMR status and stage I-II EEC status post-surgical staging treated with adjuvant radiation therapy were included. Overall survival (OS) and recurrence-free survival (RFS) rates were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed by Cox proportional hazard models for OS/RFS. Statistical analyses were conducted using statistical software.
A total of 573 patients with median age at diagnosis of 65 years (Interquartile Range (IQR) 58-71) were eligible. Most patients were White (79%), had FIGO 2009 Stage I (89.7%) and FIGO grade 1-2 (74.7%). MMR deficiency (dMMR) was reported in 191 patients (33%) while 382 patients (67%) had preserved MMR (pMMR). External beam radiation therapy (EBRT) +/- vaginal brachytherapy (VBT) was delivered to 124 patients (21.6%) while 449 patients (78.4%) received VBT alone. After a median follow-up of 41 months ((IQR) 28-60 months), the estimated OS and RFS rates for the entire cohort were 95.1% and 85%, respectively. On univariate analysis, age >65 (p < 0.001), grade 3 (p < 0.001), presence of lymphovascular space invasion (LVSI) (p = 0.039) and deep myometrial invasion (p = 0.03) were associated with worse OS. The OS was inferior in the dMMR group, however, it did not reach significance (92% vs 96.1%, p = 0.06). On multivariate analysis, older age (p < 0.001) and grade 3 (p = 0.002) were the only predictors for worse OS. On univariate analysis for RFS, age >65 (p = 0.02), grade 3 (p = 0.018) and dMMR (72.9% vs 91%, p < 0.001) were associated with worse RFS. On multivariate analysis, age >65 (p = 0.015) and dMMR (p < 0.001) were significant predictors of worse RFS.
Preliminary data from 7 out of 11 participating institutions showed that dMMR status leads to significantly decreased RFS in patients with early-stage EEC. While awaiting the results of NRG GYN020 and RAINBO prospective trials, this large study suggests that treatment intensification could be warranted in patients with dMMR early-stage EEC.
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Details
- Title
- Prognostic Impact of Mismatch Repair Deficiency on Stage I-II Endometrioid Endometrial Cancer Treated with Adjuvant Radiation Therapy: A Multi-Institutional Analysis
- Creators
- Z. Sherwani - Rutgers, The State University of New JerseyJ. Alegun - Rutgers, The State University of New JerseyA.L. Russo - Massachusetts General HospitalS. Damast - Yale UniversityK.V. Albuquerque - The University of Texas Southwestern Medical CenterC.R. Nwachukwu - The University of Texas Southwestern Medical CenterM.A. Dyer - Dana-Farber Brigham Cancer CenterE.C. Fields - Virginia Commonwealth UniversityS. Beriwal - Allegheny Health NetworkZ.D. Horne - Allegheny Health NetworkI. Vergalasova - Rutgers, The State University of New JerseyN. Ohri - Rutgers, The State University of New JerseyN.K. Taunk - University of PennsylvaniaJ.P. Chino - Duke Medical CenterE.A. Kidd - Stanford UniversityE.W. Leung - Sunnybrook Health Science CentreJ. Song - Sunnybrook Health Science CentreL. Hathout - Rutgers, The State University of New Jersey
- Publication Details
- International journal of radiation oncology, biology, physics, v 117(2), pp S8-S8
- Publisher
- Elsevier
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Other Identifier
- 991021897266804721