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Hormone therapy does not affect survival in early-stage endometrial cancer
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Fertility-preserving hormone therapy did not worsen outcomes among women with early-stage endometrial cancer, according to data published in Cancer.
“Standard primary treatment for localized endometrial cancer consists of a total hysterectomy, bilateral salpingo-oophorectomy, lymph node evaluation and evaluation for extrauterine disease,” Zoë R. Greenwald, MSc, of the division of cancer epidemiology at McGill University, Montreal, and colleagues wrote. “Further treatment is based on surgical and pathological staging.”
Hormone therapy as primary treatment may postpone surgery in women who wish to preserve fertility. However, disease persistence and recurrence are common in such cases.
“Limited data are available regarding long-term survival risks, with the current conclusions drawn from observational cohort studies in which poor outcomes are rare,” the researchers wrote.
Greenwald and colleagues identified 6,339 women with low-grade, localized endometrial cancer from the Surveillance, Epidemiology and End Results database. All patients were aged younger than 45 years and had been treated between 1993 and 2012. The researchers used Kaplan-Meier methods to measure overall and cancer-specific survival, and used propensity score matching to sort patients into comparable groups by treatment: primary surgery (n = 6,178) or hormone therapy (n = 161).
The hormone therapy and surgery groups had similar all-cause mortality after 15 years of follow-up (14.1% vs. 9.3%).
The hormone therapy group appeared to have a higher cancer-specific mortality than the primary surgery group (9.2% vs. 2.1%); however, that difference was driven by three late deaths among patients in the hormone therapy group.
“These estimates lack precision due to the low numbers of patients with long-term follow-up,” the researchers wrote.
The HR for overall risk of death was 1.45 (95% CI, 0.44-4.74).
“The results of the current study indicate that the choice of hormone therapy by physicians and patients to preserve fertility, thereby postponing curative surgery, does not appear to worsen long-term survival appreciably,” Greenwald and colleagues wrote. “However, future studies will be needed to confirm this similar survival, because the indication for hormone therapy in patients with endometrial cancer may have loosened over the years, which eventually may result in worse survival if surgery is postponed in patients with more aggressive tumors.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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