Does age-adjusted Charlson comorbidity score skew survival endpoints in women with FIGO-stage III endometrial cancer?

2018 ◽  
Vol 149 ◽  
pp. 150
Author(s):  
A.I. Ghanem ◽  
A. Modh ◽  
C. Burmeister ◽  
A.R. Munkarah ◽  
M.A. Elshaikh
Keyword(s):  
Endometrial Cancer ◽  
Figo Stage ◽  
Stage Iii ◽  
Comorbidity Score ◽  
Survival Endpoints ◽  
Charlson Comorbidity Score

Impact of Age-Adjusted Charlson Comorbidity score on outcomes for patients with early-stage endometrial cancer

2013 ◽  
Vol 131 (3) ◽  
pp. 593-597 ◽  
Author(s):  
Jared R. Robbins ◽  
Omar H. Gayar ◽  
Mark Zaki ◽  
Meredith Mahan ◽  
Thomas Buekers ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Comorbidity Score ◽  
Charlson Comorbidity Score ◽  
Early Stage Endometrial Cancer

Actionable policy barriers for receiving standard of care treatment among unresected stage III non-small cell lung cancer (NSCLC) patients in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2069-2069
Author(s):  
Zhiyuan Zheng ◽  
Charles B. Simone ◽  
Stephen G. Chun ◽  
Xuesong Han ◽  
Helmneh M. Sineshaw ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Standard Of Care ◽  
Small Cell ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Comorbidity Score ◽  
Driving Time ◽  
Charlson Comorbidity Score ◽  
Standard Of Care Treatment ◽  
Nsclc Patients

2069 Background: Recent data suggests that a significant number of good performance, unresectable stage III non-small cell lung cancer (NSCLC) patients do not receive standard-of-care treatment, i.e. concurrent chemoradiotherapy (cCRT) followed by durvalumab, despite being eligible. However, little is known about actionable policy barriers to delivery of cCRT to this patient population. Methods: The National Cancer Database (2004-2016) was used to identify unresected stage III NSCLC patients aged 18-79 years with Charlson comorbidity score ≤ 1. cCRT was defined as the initiations of chemotherapy (CT) and radiation therapy (RT) that were ≤14 days (n = 53,444) apart. The remaining treatment groups included sequential CRT (sCRT; n = 16,666), CT only (n = 15,416), RT only (n = 11,579), and no first course treatment (n = 16,691). Multinomial logistic regressions were used to examine the likelihoods of receiving different treatment modalities, controlling for patient demographics, Charlson comorbidity score, health insurance, facility type, social deprivation index (SDI, a comprehensive socio-economic measure; higher SDI indicates lower socioeconomic status [SES]), driving time to facility, diagnosis year, and region. Results: Of the total 113,796 patients assessed (median age 66 years), most were male (55.7%), non-Hispanic white (81.7%), and with SDI score ≥50 (51.3%). 29.5% had Charlson comorbidity score = 1 while the rest had 0. In adjusted analyses (predicted margins), 47.0% patients received cCRT (sCRT: 14.6%; CT only: 13.5%; RT only: 10.2%; no treatment: 14.7%). Compared to the privately insured, Medicaid, Medicare, and uninsured patients were more likely to receive RT only (relative risk ratios [95%CI]: 1.93 [1.77-2.11]; 1.51 [1.41-1.61]; 1.80 [1.61-2.01], respectively) and no treatment (1.84 [1.71-1.99]; 1.54 [1.45-1.63]; 2.19 [2.01-2.40], respectively) rather than cCRT (all p < .001). Moreover, higher SDI was associated with higher likelihood of receiving RT only (highest vs lowest SDI scores: 1.42 [1.33-1.52]), or no treatment (1.46 [1.38-1.55]) rather than cCRT (all p < .001). Longer driving time was associated with higher likelihood of receiving CT only ( > 120 mins vs < 30 mins: 1.24 [1.10-1.39]), or no treatment (1.33 [1.18-1.50]) rather than cCRT (all p < .001). Conclusions: Health policies should focus on patients who are not privately insured and live in neighborhoods with low SES. Moreover, helping their transportation needs may also improve the likelihood of receiving cCRT.

A single-center analysis of adjuvant sequential versus ‘sandwich’ chemoradiotherapy for patients with stage III endometrial cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18101-e18101
Author(s):  
Janice Shen ◽  
James Newman ◽  
Jennifer Hernandez ◽  
Beatrice Bloom ◽  
Jean Kyung Lee ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
External Beam Radiotherapy ◽  
Gynecologic Oncology ◽  
Retrospective Chart Review ◽  
Figo Stage ◽  
Phase Iii ◽  
Stage Iii ◽  
Clinical Patient ◽  
Significant Difference ◽  
Chi Square Analysis

e18101 Background: To determine if the sequencing of chemotherapy with external beam radiotherapy (EBRT) in the adjuvant setting for FIGO stage III endometrial cancer impacts 2-year progression free survival (PFS). Methods: As part of our Gynecologic Oncology Multidisciplinary Group's initiative to establish an institutional guideline for the adjuvant treatment of Stage III endometrial cancer, we reviewed 144 cases identified by our cancer registry and departmental database. Treatment regimens were divided into three categories: sequential therapy with six cycles of carboplatin/taxane followed by EBRT, concurrent cisplatin for two cycles with EBRT followed by four cycles of carboplatin/taxane, or ‘sandwich’ therapy with three cycles of carboplatin/taxane followed by EBRT followed by three cycles of carboplatin/taxane. The published results of the phase III GOG-258 study called into question the efficacy of concurrent chemoradiation. Therefore, we only compared sequential versus ‘sandwich’ therapy using a Chi-Square analysis. We conducted a retrospective chart review to assess if patients were able to complete the prescribed six cycles and EBRT, and then measured their PFS at two years. We hypothesized that there would be no difference in PFS between the two groups. Results: There were no significant differences in clinical or pathologic factors between patients treated with either regimen. Ninety-four patients (65%) had stage IIIC disease. The majority of patients received six cycles of paclitaxel with carboplatin. Median EBRT dose was 45 Gy. There was no statistically significant difference in the estimated 2-year PFS between the sequential and ‘sandwich’ groups, which were 82% and 82.5%, respectively (p = 0.84). Conclusions: Adjuvant chemoradiation for FIGO stage III endometrial cancer given sequentially or in a ‘sandwich’ fashion appears to offer equally excellent early clinical patient outcomes.

Combined treatment with chemotherapy and radiotherapy in high-risk FIGO stage III–IV endometrial cancer patients

2004 ◽  
Vol 93 (2) ◽  
pp. 345-352 ◽  
Author(s):  
M BRUZZONE ◽  
L MIGLIETTA ◽  
P FRANZONE ◽  
A GADDUCCI ◽  
F BOCCARDO
Keyword(s):  
Endometrial Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Combined Treatment ◽  
Figo Stage ◽  
Stage Iii

scholarly journals Prognostic Significance of Preoperative Serum CA125, CA19-9, CA72-4, CEA, and AFP in Patients With Endometrial Cancer

2021 ◽  
Author(s):  
Zi-hao Wang ◽  
Yun-zheng Zhang ◽  
Qi-jun Wu ◽  
Yu-shan Wang ◽  
xiaoxin Ma
Keyword(s):  
Endometrial Cancer ◽  
Survival Rates ◽  
Prognostic Significance ◽  
Progression Free Survival ◽  
Figo Stage ◽  
Disease Recurrence ◽  
Stage Iii ◽  
Type Ii ◽  
Preoperative Serum ◽  
Initial Surgery

Abstract Objective: To determine the factors related to overall survival (OS) and progression-free survival (PFS) in endometrial cancer (EC) patients.Materials and methods: A retrospective cohort study of 906 EC patients was conducted at Shengjing Hospital, China Medical University. Baseline information about the patients, tumor characteristics, and data on five serum biomarkers (CA125, CA19-9, CA72-4, CEA, and AFP) were collected. Groups and their survival rates were compared using log-rank tests and Kaplan-Meier analysis, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined using univariate or multivariate Cox proportional hazard models. The outcome measures used were OS, defined as the time between surgery and death or last follow-up for surviving patients, and PFS, defined as the time from the completion of initial surgery to either first progression, disease recurrence, or death.Results: Multivariate analysis showed lower PFS associated with age ≥ 66 years (P < 0.001), type II histology (P = 0.015), low degree of tumor differentiation (P = 0.004), and FIGO stage III & IV (P = 0.002). Elevated CA125 (P = 0.042) and AFP (P = 0.016) were identified as independent biomarkers for PFS. Increased CA125 (P = 0.013), age ≥ 66 years (P < 0.001), type II histology (P＜0.001), and FIGO stage III & IV (P = 0.015) were independent factors associated with OS. Analysis of the CA125 sub-group showed that individuals with elevated CA125 andAFP (P = 0.049) had significantly lower PFS. Conclusion: This study suggests that CA125 and AFP are prognostic biomarkers for EC.

Optimal Adjuvant Management for FIGO Stage III Endometrial Cancer: Is Timing Everything?

2018 ◽  
Vol 102 (3) ◽  
pp. S222-S223
Author(s):  
C.R. Goodman ◽  
B.L.L. Seagle ◽  
E.D. Donnelly ◽  
S. Shahabi ◽  
J.B. Strauss
Keyword(s):  
Endometrial Cancer ◽  
Figo Stage ◽  
Stage Iii

scholarly journals Adjuvant brachytherapy for FIGO stage I serous or clear cell endometrial cancer

2021 ◽  
pp. ijgc-2020-002217
Author(s):  
Elizabeth B Jeans ◽  
William G Breen ◽  
Trey C Mullikin ◽  
Brittany A Looker ◽  
Andrea Mariani ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Clear Cell ◽  
Early Stage ◽  
Figo Stage ◽  
Stage I ◽  
High Dose ◽  
Vaginal Cuff ◽  
Locoregional Failure ◽  
Platinum Based Chemotherapy ◽  
Increased Risk

ObjectivesOptimal adjuvant treatment for early-stage clear cell and serous endometrial cancer remains unclear. We report outcomes for women with surgically staged International Federation of Gynecology and Obstetrics (FIGO) stage I clear cell, serous, and mixed endometrial cancers following adjuvant vaginal cuff brachytherapy with or without chemotherapy.MethodsFrom April 1998 to January 2020, women with FIGO stage IA–IB clear cell, serous, and mixed endometrial cancer underwent surgery and adjuvant vaginal cuff brachytherapy. Seventy-six patients received chemotherapy. High-dose rate vaginal cuff brachytherapy was planned to a total dose of 21 gray in three fractions using a multichannel vaginal cylinder. The primary objective was to determine the effectiveness of adjuvant vaginal cuff brachytherapy and to identify surgicopathological risk factors that could portend towards worse oncological outcomes.ResultsA total of 182 patients were included in the analysis. Median follow-up was 5.3 years (2.3–12.2). Ten-year survival was 73.3%. Five-year cumulative incidence (CI) of vaginal, pelvic, and para-aortic relapse was 1.4%, 2.1%, and 0.9%, respectively. Five-year locoregional failure, any recurrence, peritoneal relapse, and other distant recurrence was 4.4%, 11.6%, 5.3%, and 6.7%, respectively. On univariate analysis, locoregional failure was worse for larger tumors (per 1 cm) (HR 1.9, 95% CI 1.2 to 3.0, p≤0.01). Any recurrence was worse for tumors of at least 3.5 cm (HR 3.8, 95% CI 1.3 to 11.7, p=0.02) and patients with positive/suspicious cytology (HR 4.4, 95% CI 1.5 to 12.4, p≤0.01). Ten-year survival for tumors of at least 3.5 cm was 56.9% versus 86.6% for those with smaller tumors (HR 2.9, 95% CI 1.4 to 5.8, p≤0.01). Ten-year survival for positive/suspicious cytology was 50.9% versus 77.4% (HR 2.2, 95% CI 0.9 to 5.4, p=0.09). Multivariate modeling demonstrated worse locoregional failure, any recurrence, and survival with larger tumors, as well as any recurrence with positive/suspicious cytology. Subgroup analysis demonstrated improved outcomes with the use of adjuvant chemotherapy in patients with large tumors or positive/suspicious cytology.ConclusionAdjuvant vaginal cuff brachytherapy alone without chemotherapy is an appropriate treatment for women with negative peritoneal cytology and small, early-stage clear cell, serous, and mixed endometrial cancer. Larger tumors or positive/suspicious cytology are at increased risk for relapse and worse survival, and should be considered for additional upfront adjuvant treatments, such as platinum-based chemotherapy.

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