Treatment for low-grade and high-grade endometrial carcinoma after recurrence/relapse before the molecular targeted therapy era: A retrospective, propensity score-matched cohort study

Abstract

Aim

To compare the prognosis of low-grade endometrial carcinoma (LG-EC) with that of high-grade endometrial carcinoma (HG-EC) after first recurrence/relapse before the molecular targeted therapy era.

Methods

Recurrent/relapsed endometrial cancer was diagnosed in 155 women at our hospital between January 26, 1999 and February 26, 2019. Fifty of these women received paclitaxel–carboplatin, two received doxorubicin–cisplatin, and one received docetaxel–carboplatin as postoperative chemotherapy. Two women who did not receive postoperative chemotherapy received paclitaxel–carboplatin for their first recurrence/relapse. The prognosis in these 55 women was retrospectively investigated using propensity score matching.

Results

Twenty-five women had LG-EC and 30 had HG-EC. Cox proportional hazards analysis identified response to chemotherapy for the first recurrence/relapse to be a statistically significant determinant of progression-free survival and HG-EC to be a significant determinant of overall survival. After propensity score matching, median overall survival was better in women with LG-EC than in those with HG-EC (82 months [95% CI 27–not reached] vs. 31 months [95% CI 2–47], p = 0.0127). Three women survived for at least 10 years without recurrence after completion of treatment. The interval between postoperative chemotherapy and first recurrence was more than 6 months. The recurrences resolved after multimodal treatment or aggressive chemotherapy followed by 5–12 cycles of chemotherapy other than paclitaxel–carboplatin if received postoperatively.

Conclusions

The prognosis was poorer in patients with recurrent/relapsed HG-EC than in those with recurrent/relapsed LG-EC before the molecular targeted therapy era. There were no long-term recurrence-free survivors after repeat paclitaxel–carboplatin chemotherapy.