29 Low-grade endometrioid endometrial cancer with adnexal metastasis: possible de-escalation candidate for adjuvant therapy?
Bibliographic record
Abstract
According to the National Comprehensive Cancer Network clinical practice guidelines, patients with stage III endometrioid endometrial cancer are recommended to receive combination therapy with systemic chemotherapy and external beam radiotherapy. Mounting translational data proposed a concept of “restricted microenvironmental compatibility” in low-grade endometrioid endometrial cancer. In this theory, low-grade endometrioid tumors are indolent and further distant metastasis beyond the ovary is biologically limited. We hypothesized that this tumor group has good oncologic outcomes even after metastasis to the ovary. The objective of current study was to examine the association between adjuvant therapy and oncologic outcomes of patients with low-grade endometrioid endometrial cancer with metastasis to the adnexa. We retrospectively queried the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. The study population was stage IIIA grade 1–2 endometrioid endometrial cancer with ovarian or tubal metastasis only who received adjuvant therapy from 2010–2015. Patients with uterine serosal disease, nodal involvement, distant metastasis, and secondary primary cancer were excluded. The exposure was adjuvant therapy, grouped as systemic chemotherapy without external beam radiotherapy (EBRT), EBRT alone, and combination of the two. The outcome measure was endometrial cancer-specific survival. Cox proportional hazard regression model was fitted to assess the exposure-outcome association, adjusting for patient age and tumor differentiation. A total of 245 patients were evaluated. The most frequent adjuvant therapy was systemic chemotherapy alone (46.1%), followed by combination of systemic chemotherapy and EBRT (42.0%) and EBRT alone (11.8%). The median follow-up was 6.4 (IQR 5–7.8) years. The 5-year endometrial cancer-specific survival rates were 93.3% for systemic chemotherapy alone, 92.9% for EBRT alone, and 91.0% for combination therapy (P=0.963). After controlling for patient age and tumor differentiation, combination therapy (adjusted-hazard ratio 0.83, 95% confidence interval 0.36–1.89) and EBRT alone (adjusted-hazard ratio 0.86, 95% confidence interval 0.24–3.15) were not associated with endometrial cancer-specific mortality compared to systemic chemotherapy alone. This association remained robust in sensitivity analyses for grade 1 (5-year endometrial cancer-specific survival rates for systemic chemotherapy alone, EBRT alone, and both: 95.9%, 100%, and 94.9%, respectively, P=0.618) and grade 2 (91.1%, 84.6%, and 88.6%, respectively, P=0.725) lesions. Download : Download high-res image (68KB)Download : Download full-size image These results suggest that patients with low-grade endometrioid endometrial cancer with metastases to the adnexa alone have a favorable prognosis. In this cohort combination therapy may not improve oncologic outcome compared to systemic chemotherapy alone.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".