Gynecologic oncology · 2025
Adjuvant radiotherapy outcomes and prognostic factors in FIGO 2023 stage IIC endometrial cancer: One sea, different depths.
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Kahvecioglu Alper, Gultekin Melis, Yigit Ecem, Sari Sezin Yuce, Usubutun Alp, Ozdemir Deniz Ates, Arik Zafer, Gultekin Murat, Yildiz Ferah
Аннотация
OBJECTIVE: FIGO 2023 Stage IIC endometrial cancer (EC) comprises a heterogeneous group of uterine-confined, myoinvasive tumors with aggressive histological subtypes. This study aimed to evaluate treatment outcomes and identify prognostic factors in patients treated with adjuvant radiotherapy (RT), with or without chemotherapy (CTX).
METHODS: A retrospective evaluation was conducted on 1297 EC patients treated with adjuvant RT following surgical staging between 1994 and 2023. Among these, 229 patients met the FIGO 2023 Stage IIC criteria and were included in this study.
RESULTS: The cohort included 59 % high-grade endometrioid and 41 % non-endometrioid EC. Vaginal brachytherapy was the primary RT modality (63 %), with 38 % receiving combined CTX and RT. Over a median follow-up of 64.5 months, recurrences occurred in 14 %, primarily as distant metastases (DM), while locoregional control (LRC) was 95 %. Five-year overall survival (OS) and progression-free survival (PFS) rates were 88 % and 82 %, respectively. Advanced age (≥ 60 years) predicted worse OS (HR: 5.9, p < 0.001) and PFS (HR: 7.1, p < 0.001), and endocervical stromal invasion was independently associated with worse PFS (HR: 2.79, p = 0.003). CTX improved OS and PFS in non-endometrioid tumors but showed no benefit in high-grade endometrioid cancer.
CONCLUSIONS: Although FIGO 2023 Stage IIC EC shows diverse outcomes, adjuvant RT provides excellent LRC, while DM remain challenging. Endocervical stromal invasion remains a key prognostic factor, predicting poorer PFS, while CTX shows benefit exclusively in non-endometrioid tumors. These findings emphasize the critical need for personalized risk-grouping and adjuvant treatment strategies.
METHODS: A retrospective evaluation was conducted on 1297 EC patients treated with adjuvant RT following surgical staging between 1994 and 2023. Among these, 229 patients met the FIGO 2023 Stage IIC criteria and were included in this study.
RESULTS: The cohort included 59 % high-grade endometrioid and 41 % non-endometrioid EC. Vaginal brachytherapy was the primary RT modality (63 %), with 38 % receiving combined CTX and RT. Over a median follow-up of 64.5 months, recurrences occurred in 14 %, primarily as distant metastases (DM), while locoregional control (LRC) was 95 %. Five-year overall survival (OS) and progression-free survival (PFS) rates were 88 % and 82 %, respectively. Advanced age (≥ 60 years) predicted worse OS (HR: 5.9, p < 0.001) and PFS (HR: 7.1, p < 0.001), and endocervical stromal invasion was independently associated with worse PFS (HR: 2.79, p = 0.003). CTX improved OS and PFS in non-endometrioid tumors but showed no benefit in high-grade endometrioid cancer.
CONCLUSIONS: Although FIGO 2023 Stage IIC EC shows diverse outcomes, adjuvant RT provides excellent LRC, while DM remain challenging. Endocervical stromal invasion remains a key prognostic factor, predicting poorer PFS, while CTX shows benefit exclusively in non-endometrioid tumors. These findings emphasize the critical need for personalized risk-grouping and adjuvant treatment strategies.