Analysis of the relapse patterns and risk factors of endometrial cancer following postoperative adjuvant chemotherapy in a phase III randomized clinical trial

Hiroyuki Nomura, Daisuke Aoki, Nobuyuki Susumu, Mika Mizuno, Hidekatsu Nakai, Masahide Arai, Shin Nishio, Hideki Tokunaga, Toru Nakanishi, Yoh Watanabe, Nobuo Yaegashi, Yoshihito Yokoyama, Kazuhiro Takehara

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Abstract

Objective: This study was to analyze patterns and risk factors of relapse after postoperative adjuvant chemotherapy for endometrial cancer. Methods: Among patients enrolled in a randomized phase III trial (JGOG2043) investigating the efficacy of adjuvant chemotherapy for endometrial cancer at a high risk of progression, the recurrent patients were studied. Clinical information were collected, and correlation between relapse-related factors and clinicopathological factors were analyzed. Results: Among 193 patients analyzed, 50% had local relapse and 63% had distant relapse. Local relapse involved regional lymph nodes in 30%, while distant relapse involved the abdominal cavity in 42%. Imaging was used to confirm relapse in 83%, and the median disease-free interval (DFI) was 11.5 months. Factors showing a significant correlation with DFI ≤12 months were residual tumor at surgery (p < 0.01), Grade 3 histology (p < 0.01), and lymph node metastasis (p = 0.03). In contrast, treatment with paclitaxel and carboplatin showed a significant correlation with DFI >12 months (p = 0.04). The median post-relapse overall survival (RS) was 23.9 months. In multivariate analysis, CA125 ≥ 100 U/mL prior to relapse (p < 0.01), distant metastasis (p < 0.01), DFI ≤ 12 months (p = 0.02), and not performing para-aortic lymphadenectomy (p = 0.01) were independently related to poor RS. Conclusions: Relapse of endometrial cancer following adjuvant chemotherapy often occurs by 1 year after treatment, with common relapse sites of the abdominal cavity and regional lymph nodes. Among treatment-related factors, RS was correlated with DFI and para-aortic lymphadenectomy.

Original languageEnglish
JournalGynecologic Oncology
DOIs
Publication statusAccepted/In press - 2019 Jan 1

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Phase III Clinical Trials
Adjuvant Chemotherapy
Endometrial Neoplasms
Randomized Controlled Trials
Recurrence
Abdominal Cavity
Lymph Node Excision
Survival
Lymph Nodes
Residual Neoplasm

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

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Analysis of the relapse patterns and risk factors of endometrial cancer following postoperative adjuvant chemotherapy in a phase III randomized clinical trial. / Nomura, Hiroyuki; Aoki, Daisuke; Susumu, Nobuyuki; Mizuno, Mika; Nakai, Hidekatsu; Arai, Masahide; Nishio, Shin; Tokunaga, Hideki; Nakanishi, Toru; Watanabe, Yoh; Yaegashi, Nobuo; Yokoyama, Yoshihito; Takehara, Kazuhiro.

In: Gynecologic Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Nomura, H, Aoki, D, Susumu, N, Mizuno, M, Nakai, H, Arai, M, Nishio, S, Tokunaga, H, Nakanishi, T, Watanabe, Y, Yaegashi, N, Yokoyama, Y & Takehara, K 2019, 'Analysis of the relapse patterns and risk factors of endometrial cancer following postoperative adjuvant chemotherapy in a phase III randomized clinical trial', Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2019.09.023
Nomura, Hiroyuki ; Aoki, Daisuke ; Susumu, Nobuyuki ; Mizuno, Mika ; Nakai, Hidekatsu ; Arai, Masahide ; Nishio, Shin ; Tokunaga, Hideki ; Nakanishi, Toru ; Watanabe, Yoh ; Yaegashi, Nobuo ; Yokoyama, Yoshihito ; Takehara, Kazuhiro. / Analysis of the relapse patterns and risk factors of endometrial cancer following postoperative adjuvant chemotherapy in a phase III randomized clinical trial. In: Gynecologic Oncology. 2019.
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T1 - Analysis of the relapse patterns and risk factors of endometrial cancer following postoperative adjuvant chemotherapy in a phase III randomized clinical trial

AU - Nomura, Hiroyuki

AU - Aoki, Daisuke

AU - Susumu, Nobuyuki

AU - Mizuno, Mika

AU - Nakai, Hidekatsu

AU - Arai, Masahide

AU - Nishio, Shin

AU - Tokunaga, Hideki

AU - Nakanishi, Toru

AU - Watanabe, Yoh

AU - Yaegashi, Nobuo

AU - Yokoyama, Yoshihito

AU - Takehara, Kazuhiro

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: This study was to analyze patterns and risk factors of relapse after postoperative adjuvant chemotherapy for endometrial cancer. Methods: Among patients enrolled in a randomized phase III trial (JGOG2043) investigating the efficacy of adjuvant chemotherapy for endometrial cancer at a high risk of progression, the recurrent patients were studied. Clinical information were collected, and correlation between relapse-related factors and clinicopathological factors were analyzed. Results: Among 193 patients analyzed, 50% had local relapse and 63% had distant relapse. Local relapse involved regional lymph nodes in 30%, while distant relapse involved the abdominal cavity in 42%. Imaging was used to confirm relapse in 83%, and the median disease-free interval (DFI) was 11.5 months. Factors showing a significant correlation with DFI ≤12 months were residual tumor at surgery (p < 0.01), Grade 3 histology (p < 0.01), and lymph node metastasis (p = 0.03). In contrast, treatment with paclitaxel and carboplatin showed a significant correlation with DFI >12 months (p = 0.04). The median post-relapse overall survival (RS) was 23.9 months. In multivariate analysis, CA125 ≥ 100 U/mL prior to relapse (p < 0.01), distant metastasis (p < 0.01), DFI ≤ 12 months (p = 0.02), and not performing para-aortic lymphadenectomy (p = 0.01) were independently related to poor RS. Conclusions: Relapse of endometrial cancer following adjuvant chemotherapy often occurs by 1 year after treatment, with common relapse sites of the abdominal cavity and regional lymph nodes. Among treatment-related factors, RS was correlated with DFI and para-aortic lymphadenectomy.

AB - Objective: This study was to analyze patterns and risk factors of relapse after postoperative adjuvant chemotherapy for endometrial cancer. Methods: Among patients enrolled in a randomized phase III trial (JGOG2043) investigating the efficacy of adjuvant chemotherapy for endometrial cancer at a high risk of progression, the recurrent patients were studied. Clinical information were collected, and correlation between relapse-related factors and clinicopathological factors were analyzed. Results: Among 193 patients analyzed, 50% had local relapse and 63% had distant relapse. Local relapse involved regional lymph nodes in 30%, while distant relapse involved the abdominal cavity in 42%. Imaging was used to confirm relapse in 83%, and the median disease-free interval (DFI) was 11.5 months. Factors showing a significant correlation with DFI ≤12 months were residual tumor at surgery (p < 0.01), Grade 3 histology (p < 0.01), and lymph node metastasis (p = 0.03). In contrast, treatment with paclitaxel and carboplatin showed a significant correlation with DFI >12 months (p = 0.04). The median post-relapse overall survival (RS) was 23.9 months. In multivariate analysis, CA125 ≥ 100 U/mL prior to relapse (p < 0.01), distant metastasis (p < 0.01), DFI ≤ 12 months (p = 0.02), and not performing para-aortic lymphadenectomy (p = 0.01) were independently related to poor RS. Conclusions: Relapse of endometrial cancer following adjuvant chemotherapy often occurs by 1 year after treatment, with common relapse sites of the abdominal cavity and regional lymph nodes. Among treatment-related factors, RS was correlated with DFI and para-aortic lymphadenectomy.

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