Trends in the Utilization of Neoadjuvant and Adjuvant Chemotherapy in Advanced Stage Endometrial Cancer
Abstract
Introduction and Objective. The incidence of endometrial cancer has increased by 1% annually in recent decades. However, it remains one of the only cancers for which overall survival simultaneously decreased1. The standard of care for advanced stage endometrial cancer (ASEC) is primary debulking surgery (PDS) followed by adjuvant chemotherapy (ACT). The role of chemotherapy in ASEC has expanded to include neoadjuvant chemotherapy (NACT) followed by interval debulking surgery, which has been shown to improve peri-operative morbidity as compared to PDS alone. This study aims to analyze trends in the utilization of ACT and NACT for patients diagnosed with ASEC between 2004-2020 using the National Cancer Database. Methods. Our analytic cohort included patients diagnosed with ASEC (FIGO III and IV) between 2004-2020. Our study compared two analytical arms: patients receiving NACT versus patients receiving ACT, with data included on patients receiving other treatment modalities such as chemotherapy alone, surgery alone, or no treatment/ no recorded treatment. We performed propensity-score matching using age, race, ethnicity, facility, median income, insurance, comorbidity score, and FIGO stage. We used logistic regression to evaluate the impact of demographic variables on utilization of NACT vs ACT. We performed a Chi-square analysis to quantify the annual usage of each treatment modality between 2004-2020. Results. Of the 53,694 individuals diagnosed with ASEC (FIGO III and IV), 5975 (11.1%) received NACT and 17,714 (33%) received ACT. Our analysis found that academic programs (OR 1.426, 95%CI: 1.191-1.709) and FIGO stages IIIB (OR 3.507, 95%CI: 2.775-4.430), IVA (OR 2.533, 95%CI: 1.957-3.279), and IVB (OR 3.727, 95%CI 3.031-4.583) were associated with greater utilization of NACT compared to ACT. Chi-square analysis found that between 2004-2020, ACT use decreased from a high of 39.9%-22.8%, while NACT use increased from 4.3%-20.8%. Conclusions-Implications. This study evaluated trends in the utilization of NACT and ACT in treating ASEC. We observed that ACT is the predominant treatment modality; however, NACT has seen a drastic rise in utilization since 2004, especially in academic programs and at higher FIGO stages (IIIB-IVB). Additional studies evaluating survival outcomes of ASEC in these populations are necessary.
Keywords
endometrial cancer, neoadjuvant therapy, adjuvant chemotherapy
Presentation Type
Poster Presentation
Trends in the Utilization of Neoadjuvant and Adjuvant Chemotherapy in Advanced Stage Endometrial Cancer
Introduction and Objective. The incidence of endometrial cancer has increased by 1% annually in recent decades. However, it remains one of the only cancers for which overall survival simultaneously decreased1. The standard of care for advanced stage endometrial cancer (ASEC) is primary debulking surgery (PDS) followed by adjuvant chemotherapy (ACT). The role of chemotherapy in ASEC has expanded to include neoadjuvant chemotherapy (NACT) followed by interval debulking surgery, which has been shown to improve peri-operative morbidity as compared to PDS alone. This study aims to analyze trends in the utilization of ACT and NACT for patients diagnosed with ASEC between 2004-2020 using the National Cancer Database. Methods. Our analytic cohort included patients diagnosed with ASEC (FIGO III and IV) between 2004-2020. Our study compared two analytical arms: patients receiving NACT versus patients receiving ACT, with data included on patients receiving other treatment modalities such as chemotherapy alone, surgery alone, or no treatment/ no recorded treatment. We performed propensity-score matching using age, race, ethnicity, facility, median income, insurance, comorbidity score, and FIGO stage. We used logistic regression to evaluate the impact of demographic variables on utilization of NACT vs ACT. We performed a Chi-square analysis to quantify the annual usage of each treatment modality between 2004-2020. Results. Of the 53,694 individuals diagnosed with ASEC (FIGO III and IV), 5975 (11.1%) received NACT and 17,714 (33%) received ACT. Our analysis found that academic programs (OR 1.426, 95%CI: 1.191-1.709) and FIGO stages IIIB (OR 3.507, 95%CI: 2.775-4.430), IVA (OR 2.533, 95%CI: 1.957-3.279), and IVB (OR 3.727, 95%CI 3.031-4.583) were associated with greater utilization of NACT compared to ACT. Chi-square analysis found that between 2004-2020, ACT use decreased from a high of 39.9%-22.8%, while NACT use increased from 4.3%-20.8%. Conclusions-Implications. This study evaluated trends in the utilization of NACT and ACT in treating ASEC. We observed that ACT is the predominant treatment modality; however, NACT has seen a drastic rise in utilization since 2004, especially in academic programs and at higher FIGO stages (IIIB-IVB). Additional studies evaluating survival outcomes of ASEC in these populations are necessary.