TOPLINE

Adjuvant chemotherapy was associated with substantially longer median overall survival (28 vs 10 months) in patients undergoing pelvic exenteration for gynecologic cancers with pelvic lymph node metastasis. Chemotherapy was also associated with significantly longer median disease-free survival (DFS; 20 vs 7 months) and cancer-specific survival (28 vs 13 months).

METHODOLOGY

• Previous studies have shown that pelvic lymph node metastasis is associated with poor survival outcomes after pelvic exenteration, but evidence on the role of postoperative chemotherapy in this setting is limited.
• To test this, researchers conducted a secondary analysis of the international, multicenter, retrospective Complications and Recurrence After Pelvic Exenteration (COREPEX) study, which included 121 patients with cervical, vaginal, vulvar, or endometrial cancer who underwent anterior or total pelvic exenteration between January 1, 2005, and March 31, 2023.
• Patients had histologically confirmed pelvic lymph node metastases and were stratified according to whether they received adjuvant chemotherapy (49 patients, 40.5%) or not (72 patients, 59.5%).
• Among patients receiving adjuvant chemotherapy, the median number of cycles was 6. Platinum-based regimens were used in 71.4% of patients, most commonly carboplatin plus paclitaxel.
• The median age was 51 years, and the median follow-up time was 57.0 months.

TAKEAWAY

• Adjuvant chemotherapy vs no chemotherapy was associated with significantly longer median overall survival (28 months vs 10 months; P < .001) and cancer-specific survival (28 months vs 13 months; P = .001).
• Patients receiving adjuvant chemotherapy vs those receiving no chemotherapy also had significantly longer median DFS (20 months vs 7 months; P = .001).
• Multivariable analysis identified adjuvant chemotherapy as the only independent factor associated with longer overall survival (hazard ratio [HR], 0.39; P < .001) and DFS (HR, 0.44; P < .001). When combined with the COREPEX prognostic score, adjuvant chemotherapy remained independently associated with a lower risk for recurrence (HR, 0.48; P = .003) and death (HR, 0.45; P = .001).
• Pelvic exenteration performed for persistent disease (vs other disease states) was independently associated with worse overall survival (HR, 2.33; P = .003) and DFS (HR, 2.03; P = .01).

IN PRACTICE

“We showed that administration of adjuvant chemotherapy was associated with improved survival in patients undergoing pelvic exenteration for gynecologic cancers with metastatic pelvic lymph nodes” and was “an independent protective factor toward risk of recurrence and death,” the authors concluded.

SOURCE

The study, led by Nicola Bizzarri, PhD, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, and Sahar Salehi, PhD, Karolinska University Hospital and Karolinska Institutet, Stockholm, was published online as a Research Letter on June 26 in JAMA Network Open.

LIMITATIONS

Limitations included the retrospective design, potential selection bias, heterogeneity in chemotherapy regimens, lack of toxicity data, lack of immunotherapy use as these therapies were not widely incorporated into management during much of the study period, and inability to account for patients who were unable to receive chemotherapy because of poor postoperative condition.

DISCLOSURES

David Cibula, MD, disclosed receiving advisory board fees from AstraZeneca, GSK, Karyopharm Therapeutics Inc, MSD, F. Hoffmann-La Roche AG, and AbbVie Inc outside the submitted work. Gwenael Ferron, PhD, reported being a cofounder of See2cure outside the submitted work. Alejandra Martinez, PhD, disclosed receiving consulting fees from MSD and GSK outside the submitted work. No other conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.