Although primary debulking surgery (PDS) is frequently regarded as the gold standard for stage IV endometrial cancer therapy, it is linked with severe morbidity and low mortality. As an alternative therapeutic method, neoadjuvant chemotherapy (NACT) has been offered. For this study researchers wanted to ascertain the utilization and results of NACT in women with stage IV endometrial cancer.
The National Cancer Database was utilized in this cohort analysis to identify women with stage IV endometrial cancer who were treated between January 1, 2010, and December 31, 2015. The study only included women aged 70 or younger with no comorbidities. The women were divided into two groups based on whether they received NACT or PDS. To balance the clinical features of the groups, a propensity score analysis with inverse probability weighting was conducted. To account for time-varying dangers associated with the usage of NACT, survival was investigated using flexible parametric Royston-Parmer models. An intention-to-treat (ITT) analysis was conducted, as well as a per-protocol (PP) analysis that included only women who underwent both chemotherapy and surgery. The data was evaluated between March 15, 2018, and July 20, 2018.
NACT was utilized in 952 women with stage IV endometrial cancer out of a total of 4890 women (median age, 60 years [interquartile range, 54-65 years]) (19.5%). NACT use rose from 106 of 661 women (16.0%; 95% CI, 13.2% -18.8%) in 2010 to 224 of 938 women (23.9%; 95% CI, 21.2%-26.6%) in 2015 (P<.001). A more recent year of diagnosis (Risk ratio [RR], 1.42; 95% CI, 1.21-1.79 for 2015 vs 2010), stage IVB disease (RR, 1.31; 95% CI, 1.03-1.67 for stage IVB vs IVA), and serous histology (RR, 1.38; 95% CI, 1.13-1.69 for serous vs endometrioid histology) were all associated with NACT use in a multivariate model. NACT usage had a time-varying link with survival in a propensity score–balanced population. The use of NACT was related to lower mortality for the first 3 months following diagnosis in the ITT analysis (hazard ratio [HR] at 2 months, 0.81; 95% CI, 0.66-0.99). The survival curves crossed at 4 months, and NACT was associated with increased mortality (HR at 6 months, 1.23; 95% CI, 1.09-1.39). The use of NACT was linked with lower mortality for the first 8 months following diagnosis in the PP analysis (HR at 6 months, 0.79; 95% CI, 0.63-0.98). The survival curves cross at 9 months, and NACT was associated with increased mortality (HR at 12 months, 1.22; 95% CI, 1.04-1.43).
Reference:jamanetwork.com/journals/jamanetworkopen/fullarticle/2773827?resultClick=1
