1. The role of adjuvant treatment for early-stage uterine clear cell carcinomas.
- Author
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Orellana, T.J., Garrett, A.A., Soong, T.R., Rives, T., Courtney-Brooks, M., Taylor, S.E., Lesnock, J., Berger, J., Boisen, M., Coffman, L., Buckanovich, R., Mahdi, H., Comerci, J.C., Beriwal, S., Sukumvanich, P., Edwards, R.P., Bhargava, R., and Olawaiye, A.B.
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ADJUVANT chemotherapy , *RENAL cell carcinoma , *RADIOTHERAPY , *ENDOMETRIAL cancer - Abstract
Uterine clear cell carcinoma is a rare and aggressive subtype of endometrial carcinoma. Prospective clinical trials have not been feasible for this rare tumor, and data regarding the optimal adjuvant treatment regimen for early-stage uterine clear cell carcinomas is limited. Our study's objective was to determine if adjuvant chemotherapy or radiation therapy improves patients' outcomes in stage I and II uterine clear cell carcinoma. Patients with stage I and II uterine clear cell carcinoma were identified at a single institution. All cases were reviewed by a gynecologic pathologist. Both pure and mixed non-serous uterine clear cell carcinomas were included. Primary outcomes were recurrence free survival and overall survival. A total of 71 patients were identified including 39 (55%) pure and 32 (45%) mixed clear cell carcinoma. Most patients were FIGO stage IA (77.5%). Most patients (n = 58, 82%) received adjuvant therapy, including 43 (61%) receiving chemotherapy, 50 (70%) receiving radiation therapy, and 35 (49%) receiving both. Recurrence free survival was not significantly different among patients receiving no or <6 cycles of chemotherapy versus patients receiving 6 cycles of chemotherapy (p = 0.39). However, median OS was significantly different among patients receiving no or <6 cycles of chemotherapy versus 6 cycles of chemotherapy (p = 0.004). On univariable analysis, 6 cycles of chemotherapy was significantly associated with improved OS (HR 0.1, 95% CI 0.01–0.07). Presence of LVSI, mutated p53, number of pelvic and para-aortic lymph nodes assessed, adjuvant chemotherapy (any number of cycles), and >2 medical co-morbidities were not significant predictors of OS on univariable analysis. On multivariable analysis, 6 cycles of adjuvant chemotherapy remained a significant predictor of improved OS (HR 0.1, 95% CI 0.01–0.8). In this study, administration of 6 cycles of chemotherapy appears to significantly improve OS. This finding suggests consideration of 6 cycles of adjuvant chemotherapy in patients with early-stage uterine clear cell carcinoma, however clinical trials are needed to confirm these findings. • Pathologic confirmation of pure or mixed uterine clear cell carcinoma was performed for each patient. • Receipt of adjuvant therapy was not associated with improvements in RFS. • Receipt of a full 6 cycles of adjuvant chemotherapy was associated with improved OS in this cohort. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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