Neoadjuvant Chemotherapy Versus Primary Cytoreductive Surgery for Metastatic Endometrial Cancer

Area of Science:

• Gynecologic Oncology
• Medical Oncology
• Clinical Research

Background:

• Stage IV endometrial cancer presents advanced disease, necessitating evaluation of treatment strategies.
• Neoadjuvant chemotherapy (NACT) and primary debulking surgery (PDS) are key treatment modalities.
• Understanding the comparative outcomes of NACT versus PDS is crucial for optimizing patient care.

Purpose of the Study:

• To compare the utilization patterns and clinical outcomes of NACT versus PDS in stage IV endometrial cancer.
• To assess the impact of NACT and PDS on survival in advanced endometrial cancer patients.

Main Methods:

• Utilized the National Cancer Database to identify and categorize 18,205 patients with stage IV endometrial cancer based on NACT or PDS.
• Applied propensity score weighting (inverse probability of treatment weighting) for comparative analysis.
• Conducted intention-to-treat (ITT) and per-protocol (PP) analyses to evaluate survival outcomes.

Main Results:

• NACT utilization significantly increased from 30.3% in 2010 to 73.8% in 2021.
• Multivariable analysis identified factors associated with NACT, including recent diagnosis year, race/ethnicity, insurance, histology, and comorbidities.
• ITT analysis showed no early mortality difference, but higher mortality after 4 months for NACT.
• PP analysis indicated lower mortality within 24 months for NACT but higher mortality after 24 months compared to PDS.

Conclusions:

• NACT use has expanded in metastatic endometrial cancer treatment.
• Primary debulking surgery followed by chemotherapy is associated with higher early mortality but better long-term outcomes than NACT followed by surgery.