Journal article
A proposal for a new classification of “unfavorable risk criteria” in patients with stage I endometrial cancer
International journal of gynecological cancer, v 29(7), pp 1086-1093
Sep 2019
PMID: 31474587
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BackgroundRandomized trials describe differing sets of high–intermediate risk criteria.ObjectiveTo use the National Cancer Database to compare the impact of radiation therapy in patients with stage I endometrial cancer meeting different criteria, and define a classification of “unfavorable risk.”MethodsPatients with stage I endometrial cancer between January 2010 and December 2014 were identified in the National Cancer Database and stratified into two cohorts: (1) patients meeting Gynecologic Oncology Group (GOG)-99 criteria only for high–intermediate risk, but not Post-Operative Radiation Therapy in Endometrial Carcinoma (PORTEC)-1 criteria and (2) those meeting PORTEC-1 criteria only. High-risk stage I patients with both FIGO stage IB (under FIGO 2009 staging) and grade 3 disease were excluded. In each cohort, propensity score-matched survival analyses were performed. Based on these analyses, we propose a new classification of unfavorable risk. We then analyzed the association of adjuvant radiation with survival, stratified by this classification.ResultsWe identified 117,272 patients with stage I endometrial cancer. Of these, 11,207 patients met GOG-99 criteria only and 5,920 patients met PORTEC-1 criteria only. After propensity score matching, adjuvant radiation therapy improved survival (HR=0.73; 95% CI 0.60 to 0.89; p=0.002) in the GOG-99 only cohort. However, there was no benefit of adjuvant radiation (HR=0.89; 95% CI 0.69 to 1.14; p=0.355) in the PORTEC-1 only cohort. We, therefore, defined unfavorable risk stage I endometrial cancer as two or more of the following risk factors: lymphovascular invasion, age ≥70, grade 2–3 disease, and FIGO stage IB. Adjuvant radiation improved survival in stage I patients with adverse risk factors (HR=0.74; 95% CI 0.68 to 0.80; p<0.001), but not in other stage I patients (HR=1.02; 95% CI 0.91 to 1.15; p=0.710; p interaction <0.001).ConclusionOur study showed that adjuvant radiation was associated with an overall survival benefit in patients meeting GOG-99 criteria only; however, no survival benefit was seen in patients meeting PORTEC-1 criteria only. We propose a definition of unfavorable risk stage I endometrial cancer: ≥2 risk factors from among lymphovascular invasion, age ≥70, grade 2–3 disease, and FIGO stage IB disease.
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Details
- Title
- A proposal for a new classification of “unfavorable risk criteria” in patients with stage I endometrial cancer
- Creators
- Richard Li - City Of Hope National Medical CenterAshwin Shinde - City Of Hope National Medical CenterErnest Han - City Of Hope National Medical CenterStephen Lee - City Of Hope National Medical CenterSushil Beriwal - UPMC Hillman Cancer CenterMatthew Harkenrider - Loyola University ChicagoMitchell Kamrava - Cedars-Sinai Medical CenterYi-Jen Chen - Radiation Oncology, City of Hope Medical Center, Duarte, California, USAScott Glaser - City Of Hope National Medical Center
- Publication Details
- International journal of gynecological cancer, v 29(7), pp 1086-1093
- Publisher
- British Medical Journal (BMJ)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000486848200002
- Scopus ID
- 2-s2.0-85071739052
- Other Identifier
- 991021897386304721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Obstetrics & Gynecology
- Oncology