Highlights
- •Adjuvant gemcitabine-docetaxel chemotherapy increased significantly from 2006 to 2013
- •White women were more likely to receive adjuvant chemotherapy than other ethnicities.
- •Adjuvant gemcitabine-docetaxel was not associated with improved survival.
Abstract
Objective
To assess recent trends of administering adjuvant gemcitabine-docetaxel (GD) chemotherapy
for Stage I uterine leiomyosarcoma, and to compare disease-free and overall survival
between women who received and did not receive adjuvant GD chemotherapy.
Methods
All patients diagnosed with Stage I uterine leiomyosarcoma in a California-Colorado
population-based health plan inclusive of 2006–2013 were included in a retrospective
cohort. Adjuvant GD chemotherapy rates, clinico-pathologic characteristics and survival
estimates were assessed.
Results
Of 111 women with Stage I uterine leiomyosarcoma, 33 received adjuvant GD (median
4 cycles), 77 received no chemotherapy, and 1 patient excluded for non-GD chemotherapy.
GD-chemotherapy and no-chemotherapy groups were similar with respect to age, stage
(IA/IB), uterine weight, mitotic index, body mass index, and Charlson comorbidity
score. Non-Hispanic white women were twice as likely to receive adjuvant chemotherapy
as non-white or Hispanic women (37.7 vs. 17.1%, P = 0.02). The proportion of women receiving adjuvant GD chemotherapy increased from 6.5%
in 2006–2008 to 46.9% in 2009–2013 (P < 0.001). There was no significance difference in unadjusted Kaplan-Meyer estimated
disease-free (P = 0.95) or overall survival (P = 0.43) between GD-chemotherapy and no-chemotherapy cohorts. Corresponding adjusted
Cox proportional hazard ratios for adjuvant GD chemotherapy compared to no chemotherapy
were 1.01 (95% confidence interval [CI] 0.57–1.80, P = 0.97) for recurrence and 1.28 (95% CI 0.69–2.36, P-0.48) for mortality.
Conclusions
Use of adjuvant GD chemotherapy for Stage I uterine leiomyosarcoma has increased significantly
in the last decade, despite unclear benefit. Compared to no chemotherapy, 4–6 cycles of adjuvant GD chemotherapy does not appear to alter survival outcomes.
Keywords
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Article info
Publication history
Published online: July 24, 2017
Accepted:
July 10,
2017
Received in revised form:
July 6,
2017
Received:
May 22,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
