Abstract
Improved overall survival with combined adjuvant chemotherapy and radiation in clear cell carcinoma of the uterus: A National Cancer Database study
Gynecologic oncology, Vol.208, pp.S121-S122
05/2026
DOI: 10.1016/j.ygyno.2026.01.252
Abstract
Objectives
Clear cell carcinoma is a rare, but aggressive endometrial cancer subtype. Given the rarity of the disease, prospective, randomized data is relatively lacking, and treatment is guided retrospective studies, often grouping clear cell and serous histology together with conflicting results. The objective of this study was to evaluate adjuvant treatment modalities effect on overall survival in patients with clear cell carcinoma.
Methods
This is a retrospective cohort study of patients with FIGO stage I-III endometrial clear cell carcinoma utilizing the National Cancer Database (NCDB). Data was analyzed among patients by adjuvant therapy received: no adjuvant therapy, chemotherapy alone, radiation alone, or combination chemotherapy and radiation. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to adjust for baseline differences between groups. Kaplan-Meier and Cox proportional hazard modeling were used for analysis. Primary objective was overall survival (OS).
Results
In the early-stage cohort (N = 4,170) the median OS was highest in patients receiving chemotherapy and radiation (201.7 months) compared to chemotherapy alone (155.8 months), radiation alone (148.2 months), and no adjuvant therapy (153.4 months). After IPTW adjustment, combination chemotherapy and radiation therapy were associated with significantly improved OS compared to chemotherapy alone (HR 0.773 (95%CI 0.640–0.934, p = 0.0075). No significant difference was observed between radiation alone and chemotherapy alone or no adjuvant therapy and chemotherapy alone. In subgroup analysis for patients without myoinvasion (N = 727), the benefit of combined therapy persisted (HR 0.381 (95%CI 0.0.193-0.755, p = 0.0083)
In the stage III cohort (N = 1754), median OS was longest with combined adjuvant therapy (76.3 months), followed by chemotherapy alone (44.9 months), radiation alone (35.7 months), and no adjuvant therapy (26.9 months). IPTW adjusted Cox regression confirmed a significant OS benefit for combined adjuvant chemotherapy and radiation compared to chemotherapy alone (HR = 0.705 (95%CI 0.612–0.812, p < 0.0001). No significant OS difference between radiation therapy alone versus chemotherapy alone; chemotherapy alone was superior to no adjuvant therapy (HR 0.80, 95%CI 0.653-0.974, p = 0.0266).
Conclusions
Combined adjuvant chemotherapy and radiation is associated with significantly improved overall survival compared to other treatment groups. These findings support the use of combined modality treatment in patients with stage I-III clear cell carcinoma.
Details
- Title: Subtitle
- Improved overall survival with combined adjuvant chemotherapy and radiation in clear cell carcinoma of the uterus: A National Cancer Database study
- Creators
- Andrew Polio - University of IowaAdrienne Esposito - University of Iowa Hospitals and Clinics, Iowa City, United StatesJesus Gonzalez Bosquet - University of IowaMichael Goodheart - University of IowaVincent Wagner - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Gynecologic oncology, Vol.208, pp.S121-S122
- DOI
- 10.1016/j.ygyno.2026.01.252
- ISSN
- 0090-8258
- eISSN
- 1095-6859
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 05/2026
- Academic Unit
- Obstetrics and Gynecology
- Record Identifier
- 9985157520502771
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