Longitudinal effects of adjuvant chemotherapy and lymph node staging on patient-reported outcomes in endometrial cancer survivors: a prospective cohort study

Abstract

BACKGROUND: Most patients with endometrial cancer with localized disease are effectively treated and survive for a long time. The primary treatment is hysterectomy, to which surgical staging procedures may be added to assess the need for adjuvant therapy. Longitudinal data on patient-reported outcomes comparing different levels of primary treatment are lacking, especially when adjuvant radiotherapy is omitted. OBJECTIVE: We assessed the impact of lymphadenectomy and adjuvant chemotherapy on patient-reported symptoms, function, and quality of life. We hypothesized that these treatment modalities would substantially affect patient-reported outcomes at follow-up. STUDY DESIGN: We prospectively included patients with endometrial cancer enrolled in the ongoing MoMaTEC2 study (ClinicalTrials.gov Identifier: NCT02543710). Patients were asked to complete the patientreported outcome questionnaires European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EN24 preoperatively and at 1 and 2 years of follow-up. Functional domains and symptoms were analyzed for the whole cohort and by treatment received. To assess the effect of the individual treatment modifications, we used mixed regression models. RESULTS: Baseline data were available for 448 patients. Of these patients, 339 and 219 had reached 1-year follow-up and 2-year followup, respectively. Treatment included hysterectomy (plus bilateral salpingo-oophorectomy) alone (n¼177), hysterectomy and lymph node staging without adjuvant therapy (n¼133), or adjuvant chemotherapy irrespective of staging procedure (n¼138). Overall, patients reported improved global health status and quality of life (þ9 units; P<.001), increased emotional and social functioning, and increased sexual interest and activity (P<.001 for all) from baseline to year 1, and these outcomes remained stable at year 2. Means of functional scales and quality of life were similar to age-and sex-weighted reference cohorts. Mean tingling and numbness and lymphedema increased after treatment. The group who received adjuvant chemotherapy had a larger mean reduction in physical functioning (À6 vs þ2; P¼.002) at year 1, more neuropathy (þ30 vs þ5; P<.001; year 1) at years 1 and 2, and more lymphedema at year 1 (þ11 vs þ2; P¼.007) than the group treated with hysterectomy and salpingo-oophorectomy only. In patients not receiving adjuvant chemotherapy, patient-reported outcomes were similar regardless of lymph node staging procedures. Adjuvant chemotherapy independently increased fatigue, lymphedema, and neuropathy in mixed regression models. CONCLUSION: Patients with endometrial cancer receiving adjuvant chemotherapy reported significantly reduced functioning and more symptoms up to 2 years after treatment. For patients treated by surgery alone, surgical staging did not seem to affect the quality of life or symptoms to a measurable degree at follow-up. Therefore, subjecting patients to lymph nod...

Sentinel lymph node biopsy in high-risk endometrial cancer: performance, outcomes, and future avenues

“…no consensus has been reached regarding the best adjuvant therapy of choice for stage III patients [57].…”

Research on the Guiding Effect of CTCs on Postoperative Adjuvant Therapy for Patients with Early Stage Endometrial Cancer

“…Therapy approach was not related with a change in longevity for non-serous histology, though sufferers with elevated grade tumor and none of the nodal resection gained from EBRT. The authors of [ 19 ] evaluated how lymphadenectomy and adjuvant chemotherapy affected sufferers with symptoms, operation, and living standards. These therapy approaches, researchers expected, would have a significant impact on sufferers showed results at follow-up.…”

Therapeutic Benefit of Systematic Lymphadenectomy in Node-Negative Uterine-Confined Endometrioid Endometrial Carcinoma: Omission of Adjuvant Therapy

“…Vaginal brachytherapy may cause vaginal atrophy and subsequent stenosis [ 17 ] and severe bowel complications such as rectal bleeding [ 16 ]. Chemotherapy including platinum and/or taxane often causes peripheral neuropathy that decreases quality of life [ 18 , 19 ].…”

“…Removal of circumflex iliac nodes to the distal external iliac nodes is associated with the development of lymphedema, hence elimination of their dissection may be helpful [ 189 ]. In patients treated with surgery alone, lymph node staging procedures did not seem to affect quality of life or symptoms, suggesting that lymph node removal seems justified from the patient’s viewpoint [ 19 ]. Additionally, as external beam radiation may increase the risk of secondary cancer in the irradiated field, its use should be restricted, particularly in younger women [ 7 , 190 ].…”

“…Lymphadenectomy may have a therapeutic benefit in node-negative patients if adjuvant therapy can be omitted without decreasing oncological outcomes, because morbidities that decrease long-term quality of life of survivors associated with adjuvant therapy can be avoided [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. In this review, I discuss the characteristics of lymph node metastasis in endometrial carcinoma, the methods of lymph node assessment, and the possibility of omitting adjuvant therapy in patients with node-negative uterine-confined endometrioid carcinoma who undergo systematic lymphadenectomy.…”