Heterogeneity of outcomes of endometrial cancer patients included in prospective clinical trials

Ryan M Boone; Aaron M Praiss; Yongmei Huang; Alexander Melamed; Fady Khoury-Collado; June Y Hou; Allison Gockley; Caryn M St Clair; Dawn L Hershman; Jason D Wright

doi:10.1016/j.ygyno.2022.11.022

Heterogeneity of outcomes of endometrial cancer patients included in prospective clinical trials

Gynecol Oncol. 2023 Feb:169:70-77. doi: 10.1016/j.ygyno.2022.11.022. Epub 2022 Dec 13.

Authors

Affiliations

¹ Columbia University College of Physicians and Surgeons, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA.
² Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
³ Columbia University College of Physicians and Surgeons, New York, NY, USA; Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA.
⁴ Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA.
⁵ Columbia University College of Physicians and Surgeons, New York, NY, USA; Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA.
⁶ Columbia University College of Physicians and Surgeons, New York, NY, USA; Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA. Electronic address: jw2459@columbia.edu.

PMID: 36521351
DOI: 10.1016/j.ygyno.2022.11.022

Abstract

Objective: To assess heterogeneity in five-year overall survival of patients with endometrial cancer using a large retrospective database with cohorts defined by recent prospective clinical trials.

Methods: The National Cancer Database was used to identify patients with endometrial cancer who underwent hysterectomy from 2004 to 2016. The reported inclusion criteria for GOG-249, PORTEC-3, and GOG-258 were used to define the respective cohorts. Five-year overall survival for each cohort was stratified by tumor characteristics and adjuvant therapy regimens.

Results: A total of 89,133 patients were identified who would have fulfilled the entry criteria to GOG-249, PORTEC-3, or GOG-258. When stratified by tumor characteristics, irrespective of adjuvant therapy, five-year overall survival ranged from 59.9%-81.7% for patients meeting GOG-249 inclusion criteria, 40.2%-81.8% for patients meeting PORTEC-3 inclusion criteria, and 17.5%-75.0% for those meeting GOG-258 inclusion criteria. Analysis of subgroups by adjuvant therapy regimen revealed significant improvement in five-year overall survival for chemoradiotherapy compared to chemotherapy or radiotherapy alone for endometroid stage III and stage IVA disease and for some stages of serous and clear cell histology.

Conclusions: Recent prospective trials of adjuvant therapy for endometrial cancer have included heterogeneous cohorts of patients based on five-year overall survival rates when the populations are stratified by tumor characteristics. The variation in expected five-year overall survival for subsets of patients may result in underpowered studies or misleading results.

Keywords: Adjuvant therapy; Chemotherapy; Endometrial cancer; Hysterectomy; Uterine cancer.

MeSH terms

Chemotherapy, Adjuvant
Endometrial Neoplasms* / pathology
Female
Humans
Hysterectomy
Neoplasm Staging
Prospective Studies
Radiotherapy, Adjuvant
Retrospective Studies