Correlation between type I uterine cancer and diet and lifestyle in US-born versus immigrant Asian subgroups

Objectives: To examine outcomes in stage III endometrial cancer with respect to treatment with chemotherapy +/− radiation and the difference between lowand high-risk histology. Methods: We conducted a single-institution retrospective cohort study. All patients with stage III epithelial endometrial cancer were reviewed for clinicopathologic characteristics, cancer treatment, and outcomes. Patients with endometrioid and mucinous histology were grouped as low-risk and patients with a serous or clear cell component as high-risk histology. Results: A total of 80 patients with stage III endometrial cancer were included (60 with endometrioid and 20 with serous/clear cell). The median age was 58 and 62 years and body mass index was 32 and 30, respectively, for endometrioid and serous/clear cell. Ninety-six percent of patients had complete surgical staging. Overall recurrence was 26% and was lower in the endometrioid compared to serous/clear cell histology (15% vs. 60%, P b 0.0001). Of the 53 patients with endometrioid adenocarcinomawho received adjuvant therapy, 17% of those with chemotherapy only, 12% of thosewith chemotherapy/PVRT, and 0/ 4with chemotherapy/brachytherapy recurred. However, of the patients with high-risk histology, 56% recurred after chemotherapy only compared with 78% after chemotherapy/PVRT (P= 0.63). Five-year progression-free survival (PFS) for endometrioid histology was 83% whereas the median PFS for serous/clear cell was 22 months (P b 0.001). Five-year PFS for endometrioid histology was 87% with chemotherapy/PVRT vs. 83% with chemotherapy only (P= 0.63); 5year overall survivalwas 86% vs. 83% (P= 0.44).Median PFS for serous/ clear cell was 32 months for chemotherapy only and 13 months with chemotherapy/PVRT (P= 0.47). Median overall survival was 33 and 37 months, respectively (P= 0.91). For endometrioid histology, 71% of recurrences were extrapelvic, with one vaginal recurrence in chemotherapy/PVRT and one pelvic in chemotherapy only. For serous/clear cell histology, 83% of recurrences were distant, with one vaginal recurrence in each treatment group. Conclusions: Outcomes for patients with stage III endometrioid endometrial cancer are very favorable (15% recurrence) and similar for patients treated with chemotherapy +/− radiation. As expected, outcomes for serous and clear cell uterine cancers are poor and not significantly different for patients treated with chemotherapy +/− radiation. This provides further evidence that rare tumors such as serous and clear cell uterine cancers should be studied separately and that there is a desperate need for novel therapies in this group.