Yukio Suzuki, MD, PhD, on Endometrial Cancer: Long-Term Survival Outcomes With Hormonal Therapy in Reproductive-Age Patients

What we are going to look at is to determine the trends in and use of primary hormonal therapy use, and also long-term survival outcomes for hormonal therapy in premenopausal patient with early stage endometrial cancer. The design of this study is retrospective cohort study, and we use national cancer database which registered around 70% of newly diagnosed cases in the US. We have two major parts in this study and the fourth one is looking at the trends in and patterns of use of primary hormonal therapy in the premenopausal patient with early stage endometrial cancer. And the second one is survival outcome for the patient with early stage endometrial cancer. We included patients 18 to 49 years old and clinical stage 1 endometrial cancer and grade one [inaudible 00:01:01] 2 endometrial cancer. Main finding of our study is the utilization rate of primary hormonal therapy rose from 4% to 5% around 2004 to 2010, and it's going up to 12% to 14% in 2020. Younger age, non-white race patients who live in metropolitan area, patient who are treated at academic cancer center, patient who are treated at the facilities located at Northeast area in the US were associated with primary hormonal therapy use. In terms of tumor characteristics, grade 1 and stage 1A were associated with primary hormonal therapy use. For survival outcomes, the propensity score match cohort is well-balanced between the two primary treatment group. Overall, after 10 year follow up, the survival rate was decreased by 4.1% in hormonal therapy group compared with hysterectomy group. Hazard ratio was 1.84. In age subgroup, patient younger than 40 years old, the two primary treatment group of the survival rate was similar at any time point, five year and 10 year point. Surprisingly among age 40 to 49, the survival rate was inferior in hormonal therapy group then hysterectomy group at five year point and 10 year point. Hazard ratio was 4.94. To conclude, given the growing number of patient with early stage endometrial cancer who may desire fertility preservation, we need to consider potentially poorer prognosis when patients and provider select the primary hormonal therapy use. Shared decision making is further needed for this space and also prospective study with large sample sites should be needed for making this evidence more robust.