Survival outcomes of neoadjuvant therapy for the treatment of stage IVB endometrial adenocarcinoma

Treatment for stage IVB endometrial adenocarcinoma is multimodal. Our objective is to evaluate the utility of neoadjuvant therapy (NAT) on survival outcomes for patients with stage IVB endometrial adenocarcinoma. A multi-institutional retrospective review was completed of patients from 1996 to 2018. Descriptive analyses compared baseline characteristics of the treatment groups. A two-sample test or Wilcoxon rank-sum test was used to compare the distribution of values. Hazard ratios were estimated by Cox proportional hazards regression models. Ninety-nine patients with stage IVB endometrial adenocarcinoma who received NAT (n = 35) or primary debulking surgery (PDS) (n = 64) were included for analysis. There was no difference in residual disease between those undergoing PDS or NAT. Interval debulking was performed in 68.6%of patients receiving NAT. Patients received a median of 6 cycles (range: 1–10) of platinum-based NAT. There was no significant difference in median progression-free survival (PFS) for those receiving NAT compared to PDS (adjusted hazard ratio (aHR) = 1.59; 0.98, 2.59) or overall survival (OS) (age adjusted HR = 1.70; 1.00, 2.88). Patients who received NAT but did not proceed to surgery (IDS) were at a higher risk of death compared to those that had surgery (aHR = 2.96; 1.43, 6.16). The role of surgery was largely negated if adjuvant therapy was not administered. Patients with stage IVB endometrial cancer can receive NAT without compromising median PFS or OS. The survival differences in patients that received only primary chemotherapy or chemoradiation points to the importance of surgery. Similarly, when electing for surgery the ability to receive adjuvant therapy is important.

Advanced-stage endometrial; Neoadjuvant chemotherapy; Uterine; Interval debulking

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