Endometrial Cancer: Who Lives, Who Dies, Can We Improve Their Story?

Abstract

Background. Endometrial cancer (EC) is the most common gynecologic cancer in the United States. The objective of this cohort study was characterize the clinical and pathologic features that are associated with endometrial cancerspecific death for women cared for at a single NCIdesignated comprehensive cancer center. Patients and Methods. This is a retrospective cohort from 2014-2017 including all women who had a hysterectomy for EC. Charts were reviewed for clinical and pathologic data, focusing on survival outcomes. Results. 771 EC patients underwent hysterectomy with 760 informative for outcomes. Seventy-six (10%) deaths were related to their EC; 62 women died from recurrent EC. Non-endometrioid histology and advanced stage were predictors of recurrence and EC death. Among patients with endometrioid ECs, mismatch repair status was significantly associated with EC specific survival (RR=4.8, 95% CI 2.3-10.3; p<0.0001). Most EC patients who recurred died of their disease 62/83 (74.7%). Nearly half of the patients that recurred (27/62) had no additional therapy at the time of recurrence. Overall survival was significantly longer for those women who had additional treatment at the time of recurrence; however the improvement in overall survival with therapy at recurrence was largely attributable to effects in those women who were adjuvant therapy naïve. Conclusions. While there is benefit of treatment at the time of recurrence for treatment-naïve women; only about half of patients were able to receive therapy. There is an urgent need for continued efforts for more effective EC therapy in both the front-line and recurrent setting as well as early identification of cancer diagnosis and recurrence. The Oncologist 2021;9999:• •

Real-world treatment of German patients with recurrent and advanced endometrial cancer with a post-platinum treatment: a retrospective claims data analysis

“…The investigated patients had a very high comorbidity burden indicated by a mean CCI of 9.3, and most patients had another documented primary and/or secondary malignancy. The median OS was less than 1 year, which is generally in line with the findings of other investigations with comparable populations (Cosgrove et al 2021;Ueda et al 2011).…”

Characterization of mismatch‐repair/microsatellite instability‐discordant endometrial cancers

“…The clinical-pathologic features of the discordant cases did not differ significantly from the larger cohort and are presented in Table S1. However, a notable clinical finding in the cohort was a high recurrence rate at 36% (vs. 16.7% in MMRdeficient cases from this cohort, as previously reported, 32 despite similar clinicopathologic features).…”

“…In total, there were nine recurrences among the 25 discordant cases (36% recurrence rate). This recurrence rate is higher than previously reported in this cohort 32 when examining MMR status by IHC alone (16.7% in complete MMR-deficient cases and 9% in MMR-proficient cases;…”

“…This recurrence rate is higher than that previously reported in this cohort when examining MMR status by IHC alone. In our prior publication, 32 55 In addition to mutations in MMR genes, two cases in our cohort demonstrated mutations in POLE. In these tumors, a POLE mutation may drive genomic instability, resulting in MSI.…”

“…This recurrence rate is higher than that previously reported in this cohort when examining MMR status by IHC alone. In our prior publication, 32 the recurrence rate among MMR‐deficient cases by IHC alone was 16.7%. The high recurrence rate and the selection for MMR‐deficient cells observed on metastatic/recurrent samples may be further evidence of biologically more aggressive features in MMR‐deficient EC.…”