The influence of comorbidity on utilization of adjuvant therapies in women with stage III endometrial carcinoma.

Purpose: FIGO stage III endometrial carcinoma (EC) represents an important subgroup of uterine tumors. Adjuvant multimodality approach is often utilized. However, since the majority of patients with EC are elderly and many harbor comorbidities, they may not be candidates for optimal adjuvant therapy. The objective of this study is to evaluate the rates of adjuvant radiotherapy (RT) alone, chemotherapy (CT) alone or in combination (CRT) correlated with the age-adjusted Charlson comorbidity index (AACCI) for surgically staged FIGO stage III EC. Methodology: We identified 238 patients with FIGO stage III who had surgical staging between 1/1990 and 6/2016. AACCI was calculated at the time of hysterectomy for all patients and three groups were created accordingly; Group 1 with score of 0- 2, Group 2 with score 3-4 and Group 3 with score of ≥5. Surgical details and utilization of adjuvant therapies were compared in the 3 groups using Chi-Squared test of independence or Fisher Exact test for categorical; and Kruskal Wallis test for continuous data. Results: Median follow-up time for the study cohort was 53 months. We had 63 patients in Group 1, 94 cases in Group 2 and 81 in Group 3 representing 26%, 40% and 34% of the study cohort. Most frequent comorbidities were diabetes mellitus (26%), other malignancies (16%) and myocardial infarction (6%). There were no significant differences in surgical staging between the groups with similar rates of lymphadenectomy, omentectomy and peritoneal cytology performance. While there was no difference in utilization of RT between the groups (58% vs 57% vs 56% for the study groups respectively; p = 0.949); the utilization of CT was statistically lower in group 3 (64%) compared to groups 1 (84%) and 2 (82%) (p = 0.0056). Survival endpoints were worse in group 3 compared to rest of groups. Conclusions: Our study suggests that adjuvant radiation treatment is often prescribed to women with stage III endometrial cancer regardless of their comorbidity burden in contrast to adjuvant chemotherapy that is usually not prescribed in women with higher comorbidity burden. Reducing comorbidity burden is potentially beneficial to these groups of patients so that they can tolerate adjuvant multimodality therapies