Survival advantage associated with multimodal therapy in women with node-positive (stage-IIIC) uterine papillary serous carcinoma: a National Cancer Database study

ObjectiveUterine papillary serous carcinoma (UPSC) is an aggressive subtype of endometrial cancer. Adjuvant chemotherapy (CT) has become standard care in treatment of women with advanced-stage UPSC, but the role of consolidative radiotherapy (RT) is unclear. This study aims to evaluate survival outcomes of multimodal therapy. DesignRetrospective cohort study using a National Cancer Database (NCDB). SettingUnited States of America. SampleA total of 1816 women diagnosed with UPSC. MethodsAll women diagnosed with surgically staged FIGO (International Federation of Gynecology and Obstetrics) stage-IIIC UPSC were identified in the NCDB from January 1998 to December 2010. Overall survival (OS) was estimated using the Kaplan-Meier method. Univariate and multivariable analyses were performed to identify and control for prognostic factors. Main outcome measureOverall survival. ResultsA total of 398057 cases of uterine cancer were identified, 22106 of which were UPSC. Of these women, 14093 underwent lymph-node examination, 2902 (20.6%) were found to have stage-IIIC disease, and 1816 received chemotherapy. Younger age and higher number of total lymph nodes examined were independently predictive of receiving multimodality (CT+RT) therapy, compared with CT only. Median OS was 33.6 and 42.6months, for the CT and CT+RT groups, respectively (P<0.0005). Exploratory univariate analyses found age, comorbidity index, tumour size, and number of dissected and positive lymph nodes to be also associated with survival. Multivariable analysis controlling for the above found the use of consolidative radiotherapy to be independently predictive of improved OS, with a hazard ratio of 0.69 (95% confidence interval, 95% CI 0.56-0.84). ConclusionsPatients with stage-IIIC UPSC may benefit from multimodal treatment that includes adjuvant radiotherapy in addition to chemotherapy. Tweetable abstractIn this study of 1816 women with uterine papillary serous cancer, adjuvant radiotherapy increased survival. Tweetable abstract In this study of 1816 women with uterine papillary serous cancer, adjuvant radiotherapy increased survival.