LONG-TERM RESULTS OF TREATMENT OF ENDOMETRIAL CANCER OF HIGH-RISK STAGE I DEPENDING ON THE MORPHOLOGICAL TUMOR TYPE

The work is devoted to the study of the long-term results of treatment and the effect of adjuvant chemotherapy on the survival of patients with endometrial cancer (EC) of high-risk stage I, depending on the histological tumor type. The study included 225 patients with endometrial cancers of the IBG1 stage and nonendometrioid stage I cancer (serous, clear cell, undifferentiated carcinoma, carcinosarcomama) who received treatment in Belarus in 2006–2010. The overall (OS), cancerspecific (CSS) and disease-free (DFS) 5-year survival in high-risk EC was 66.7 ± 3.2, 77.4 ± 2.9 and 77.0 ± 2.9 % 10-year-old – 53.7 ± 4.5, 69.7 ± 4.2 and 69.3 ± 4.2 % respectively. There were no statistically significant differences in the survival, depending on the morphological tumor type, but the endometrioid carcinoma of the IBG3 stage is defined as the most favorable form of the high-risk EC, and the undifferentiated carcinoma and carcinosarcoma are the most unfavorable forms. There were no statistically significant differences in OS, CSS and DFS between the endometriod carcinoma of the IBG3 stage and the nonendometrioid forms of the EC stage I and the difference in the 5-year survival was about 10 % in favor of endometrioid carcinoma. Adjunctive chemotherapy did not improve the long-term outcome of treatment in general, as well as separately in the IBG3 stage of the endometrioid carcinoma stage and the nonendometrioid EC stage I. In the both groups, the difference in the 5-year OS was about 10 % in favor of the subgroups with chemotherapy. Thus, the question of the role of chemotherapy in treatment with high-risk EC is not resolved and requires further research.

1. Malkasian G. D. Carcinoma of the endometrium: effect of stage and grade on survival. Cancer, 1978, vol. 41, no. 3, pp. 996–1001. DOI: 10.1002/1097-0142(197803)41:3%3C996::aid-cncr2820410330%3E3.0.co;2-a

2. Trimble E. L., Kosary C., Park R. S. Lymph node sampling and survival in endometrial cancer. Gynecologic Oncology, 1998, vol. 71, no. 3, pp. 340–343. DOI: 10.1006/gyno.1998.5254

3. Kim H. S., Suh D. H., Kim M. K., Chung H. H., Park N. H., Song Y. S. Systematic lymphadenectomy for survival in patients with endometrial cancer: a meta-analysis. Japanese Journal of Clinical Oncology, 2012, vol. 42, no. 5, pp. 405–412. DOI: 10.1093/jjco/hys019

4. Hogberg T., Signorelli M., de Oliveira C. F., Fossati R., Lissoni A. A., Sorbe B., Andersson H., Grenman S., Lundgren C., Rosenberg P., Boman K., Tholander B., Scambia G., Reed N., Cormio G., Tognon G., Clarke J., Sawicki T., Zola P., Kristensen G. Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer-results from two randomised studies. European Journal of Cancer, 2010, vol. 46, no. 13, pp. 2422–2431. DOI: 10.1016/j.ejca.2010.06.002

5. Morrow C. P., Bundy B. N., Homesley H. D., Creasman W. T., Hornback N. B., Kurman R., Thigpen J. T. Doxorubicin as an adjuvant following surgery and radiation therapy in patients with high-risk endometrial carcinoma, stage I and occult stage II: a Gynecologic Oncology Group Study. Gynecologic Oncology, 1990, vol. 36, no. 2, pp. 166–171. DOI: 10.1016/0090-8258(90)90166-i

6. Susumu N., Sagae S., Udagawa Y., Niwa K., Kuramoto H., Satoh S., Kudo R. Randomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate- and high-risk endometrial cancer: a Japanese Gynecologic Oncology Group study. Gynecologic Oncology, 2008, vol. 108, no. 1, pp. 226–233. DOI: 10.1016/j. ygyno.2007.09.029

7. Maggi R., Lissoni A., Spina F., Melpignano M., Zola P., Favalli G., Colombo A., Fossati R. Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. British Journal of Cancer, 2006, vol. 95, no. 3, pp. 266–271. DOI: 10.1038/sj.bjc.6603279

8. Burke W. M., Orr J., Leitao M., Salom E., Gehrig P., Olawaiye A. B., Brewer M., Boruta D., Villella J., Herzog T., Abu Shahin F. Endometrial cancer: a review and current management: part II. SGO Clinical Practice Endometrial Cancer Working Group. Gynecologic Oncology, 2014, vol. 134, no. 3, pp. 393–402. DOI: 10.1038/sj.bjc.6603279

9. Viswanathan A. N., Macklin E. A., Berkowitz R., Matulonis U. The importance of chemotherapy and radiation in uterine papillary serous carcinoma. Gynecologic Oncology, 2011, vol. 123, no. 3, pp. 542–547. DOI: 10.1016/j.ygyno.2011.09.005

10. Koh W.-J., Abu-Rustum N. R., Bean S., Bradley K., Campos S. M., Cho K. R., Chon H. S., Chu C., Cohn D., Crispens M. A., Damast S., Dorigo O., Eifel P. J., Fisher C. M., Frederick P., Gaffney D. K., George S., Han E., Higgins S., Huh W. K., Lurain J. R., Mariani A., Mutch D., Nagel C., Nekhlyudov L., Nickles Fader A., Remmenga S. W., Reynolds R. K., Tillmanns T., Ueda S., Wyse E., Yashar C. M., McMillian N. R., Scavone J. L. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 2018, vol. 16, no. 2, pp. 170–199. DOI: 10.6004/jnccn.2018.0006

11. Colombo N., Creutzberg C., Amant F., Bosse T., Gonzalez-Martin A., Ledermann J., Marth C., Nout R., Querleu D., Raza M., Sessa C. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. International Journal of Gynecological Cancer, 2016, vol. 26, no. 1, pp. 2–30. DOI: 10.1097/igc.0000000000000609

12. Colombo N., Creutzberg C., Querleu D., Barachona M., Sessa C. eApdate: Endometrial Cancer Algorithms, 2017. Available at: http:// www.esmo. org/Guidelines/Gynaecological-Cancers/ESMO-ESGO-ESTRO-Consensus-Conference-on-Endometrial-Cancer/eUpdate-Algorithms.

13. Brierley J. D., Gospodarowicz M. K., Wittekind Ch. TNM Classification of Malignant Tumors. Wiley Blackwell, 2016, 8 ed., pp. 101–105.