The Role Of Adjuvant Therapy And Analysis Of Prognostic Factors For Survival In Apparent Stage IA Non-endometrial Carcinoma

Background The incidence of endometrial carcinoma is increasing annually.5-year overall survival rate is reported over 80%.Endometrial carcinoma has a relative good prognosis.Endometrial carcinoma is classified to two types according to histomorphology,clinical manifestation and epidemiology.Type ? is endometrioid adenocarcinoma,accounting for 70-80%of endometrial carcinoma.Type ? including endometrial serous carcinoma and clear cell carcinoma accounts for 10-15%.Type ?is associated with estrogen and progresses slowly.It is often accompanied with endometrial hyperplasia and endometrial intraepithelial neoplasia(EIN).Inversely,type ? has rarely relation with estrogen.It progresses easily and has worse prognosis which 5-year overall survival rate is less than 25%.It is generally believed that even for the early stage patients,the prognosis of type ? is worse than type I's.At present,there is no common agreement about the adjuvant therapy after the surgery of early stage type ? endometrial carcinoma.NCCN guidelines Version 2.2019 suggest observation or chemical therapy± radiotherapy for early stage type II endometrial carcinoma.Objective This study is a retrospective analysis about the clinical characteristics and prognostic factors of type II endometrial carcinoma patients treated in Qilu hospital,and the survival outcomes among the patients treated with different adjuvant therapies.Methods Type II endometrial carcinoma patients treated during Jan,2005 to Dec,2013 in Qilu hospital are included.Inclusion criteria:(1)histologic diagnosis was serous carcinoma,clear cell carcinoma,undifferentiated carcinoma,carcinosarcoma and mixed carcinoma which contains any percentage of type ? histology;(2)FIGO stage IA;(3)had done hysterectomy and bilateral salpingo-oophorectomy.Exclusion criteria:(1)FIGO stage IB and the above;(2)non-type ? histology;(3)undone the standard operation;(4)lack the information of clinical manifestation,histology and adjuvant therapy;(5)refuse to be followed up.Adjuvant therapies include close following-up,chemotherapy,radiotherapy and chemo-radiotherapy.Take the statistical description about the patients basic clinical and pathology characteristics,make survival analysis by Kaplan-Meier and Logistic Rank test and do the multivariate analysis by COX proportional hazard model to screen the risk factors influencing prognosis using IBM SPSS 24.0.Results A total of 106 patients met the inclusion criteria and were included in this analysis.The 3-year overall survival was 87%,5-year overall survival was 75.1%.The average age was 58.6 years,and most patients(69.8%)were induced by postmenopausal vaginal bleeding and discharge.31.1%(n=33)of histologies were serous followed by clear cell(17%,n=18)and mixed type(38.7%,n=41).The majority had done pelvic lymphadenectomy,61.3%(n=65)had para-aortic lyinphadenectomy.And 40.6%(n=43)of the patients had omentectomy.50.9%(n=54)patients received adjuvant therapy,49.1%(n=52)chose to have the follow-up.There was no Statistical difference between the patients whether they accepted adjuvant therapy(CT±RT)(x2=0.302,p=0.583).In the uni-variate Kaplan-Meier analysis and Log ranking test show that:age,grade of the tumor tissue,LVSI,pelvic lymphadenectomy,para-aortic lymphadenectomy and omentectomy are associated with the prognosis of type ? endometrial carcinoma patients(p<0.10).COX proportional risk model multivariate analysis shows that elder age(OR=2.782,95%CI 1.002-7.721,p=0.050)and para-aortic lymphadenectomy(OR=0.241,95%CI 0.087-0.669,p=0.006)are associated with the prognosis statically.But the differentiation grade,LVSI and adjuvant therapy did not influence the survive of the patients with type ? endometrial carcinoma.Conclusions1.Stage IA type ? endometrial carcinoma has a worse 3-year and 5-year survival rate than type ? endometrial carcinoma.2.For early stage patients,adjuvant therapy can give to them according to their individual situations,but both have the similar survival rate.3.Multivariate analysis shows that younger age and undone para-aortic lymphadenectomy are independent factors for good prognosis of non-endometriod carcinoma.