Sawa Keymeulen

Assessment of overall survival in reproductive-age patients with 2023 International Federation of Gynecology and Obstetrics stage IA1 grade 1 endometrioid endometrial cancer

This study aimed to assess the overall survival of reproductive-age patients with non-myoinvasive stage IA1 grade 1 endometrioid endometrial cancer. This retrospective cohort study queried the Commission-on-Cancer's National Cancer Database. The study population included 21,248 patients with grade 1 endometrioid endometrial cancer with the 2023 International Federation of Gynecology and Obstetrics stage IA1 (tumor with no myoinvasion; n = 6249), IA2 (tumor with inner-half myoinvasion; n = 11,113), and IB (tumor with outer-half myoinvasion; n = 3886), who had primary hysterectomy from 2010 to 2015. The main outcome measures were 5- and 10-year overall survival rates according to patient age (<40, 40-49, and ≥50 years) and cancer stage (IA1, IA2, and IB) stratifications. Stage IA1 was the most frequent sub-stage until age 45 years. The median follow-up was 8.3 (interquartile range; 6.8-10.0) years. Among patients aged <40 years, the 5- and 10-year overall survival rates were 100% and 98.7% (95% confidence interval [CI] 94.7 to 99.7) for stage IA1, 97.6% (95% Cl 94.7 to 98.9) and 94.4% (95% CI 88.1 to 97.4) for stage IA2, and 100% and 95.2% (95% CI 82.3 to 98.8) for stage IB, respectively (p-overall = .009). Among patients aged 40 to 49 years, the 5- and 10-year overall survival rates were 99.3% (95% CI 98.4 to 99.7) and 96.5% (95% CI 94.4 to 97.8) for stage IA1, 98.1% (95% Cl 96.9 to 98.8) and 94.4% (95% CI 92.1 to 96.0) for stage IA2 and 96.0% (95% CI 90.6 to 98.3) and 86.5% (95% CI 77.5 to 92.0) for stage IB, respectively (p-overall < .001). Among patients aged ≥50 years, the 5- and 10-year overall survival rates were 96.2% (95% CI 85.6 to 96.7) and 88.5% (95% CI 87.3 to 89.6) for stage IA1, 94.9% (95% CI 94.4 to 95.3) and 85.7% (95% CI 84.8 to 86.6) for stage IA2, and 92.1% (95% CI 91.2 to 93.0) and 78.0% (95% CI 76.3 to 79.6) for stage IB, respectively (p-overall < .001). This cohort study found that reproductive-age patients, particularly, adolescent and young adults, with non-myoinvasive stage IA1 grade 1 endometrioid endometrial cancer have favorable prognosis. These data may be used as the benchmark setting the foundation for future investigation on fertility-sparing options.

Identifying the possible candidate population for adjuvant radiotherapy de-escalation for intermediate-risk cervical cancer.

To explore whether there is a possible candidate population for treatment de-escalation with active surveillance without adjuvant radiotherapy for patients with stage IB cervical cancer meeting the intermediate-risk criteria. This retrospective cohort study queried the Commission-on-Cancer's National Cancer Database in the United States. The study population included 1133 patients with node-negative, parametria-free, surgical margin-uninvolved, stage IB intermediate-risk cervical cancer (tumor size 2-4 cm with lymphovascular space invasion, or tumor size of >4 cm regardless of lymphovascular space invasion) who had primary radical hysterectomy and lymph node evaluation from 2010 to 2022. Exposure was adjuvant radiotherapy status: external beam radiotherapy with or without chemotherapy (n = 642) or active surveillance without radiotherapy (n = 491). The main outcome measure was overall survival, assessed in a propensity score inverse probability of treatment weighting cohort. At the whole-cohort level, hazard ratio (HR) for all-cause mortality comparing adjuvant radiotherapy de-escalation to adjuvant radiotherapy was 1.31 (95% confidence interval [CI] 0.92 to 1.86, p = .13). When stratified by histology type, adjuvant radiotherapy de-escalation was associated with increased all-cause mortality risk in squamous cell carcinoma (HR 1.55, 95% CI 1.02 to 2.34, p = .038) but not in adenocarcinoma or adenosquamous carcinoma (HR, 0.90; 95% CI 0.46 to 1.75, p = .75). When stratified by tumor differentiation, adjuvant radiotherapy de-escalation was associated with increased all-cause mortality risk in poorly-differentiated tumors (HR, 2.11; 95% CI 1.29 to 3.42, p =.003) but not in well- to moderately-differentiated tumors (HR, 0.83; 95% CI 0.50 to 1.37, p = .47). The results of this cohort study in the United States suggest that overall survival benefits of adjuvant radiotherapy for study-defined intermediate-risk stage IB cervical cancer may vary based on histology type and tumor differentiation. Specifically, patients with squamous cell carcinoma or poorly-differentiated tumors benefited from receiving adjuvant radiotherapy, while those with adenocarcinoma/adenosquamous carcinoma or well- to moderately-differentiated tumors did not. Whether there may be candidates for treatment de-escalation in intermediate-risk cervical cancer warrants further investigation with a prospective design.