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Introduction/Background In stage IVB endometrial carcinoma (EC), the role of cytoreductive surgery in determining prognosis is pivotal, despite the absence of robust evidence from randomized clinical trials. However, primary surgery may not be suitable due to underlying health conditions or disease burden. In these patients, current evidence supporting neoadjuvant treatment (NACT) is limited. This study aims to assess the survival impact of NACT followed by interval surgery (IDS) compared to patients undergoing primary resection (PDS). Methodology We retrospectively identified all patients with stage IVB EC who underwent both PDS and IDS, from January 2012 to December 2022 at our institution. For each patient we categorized metastatic disease spread (abdominal and distant) and intraperitoneal location (pelvic, mesogastric and upper abdominal). Results Among 196 identified patients, 77 had endometrioid EC, and 119 had non-endometrioid tumors. Metastases were limited to the abdomen in 163 cases, 33 patients had distant metastasis. Disease extended above the pelvic rim in 73% of cases, the upper abdomen was involved in 47.2% of cases. PDS was performed in 82.2% of cases, IDS in 17.8%. Complete gross resection was achieved in 86.7% of cases. Extra-abdominal disease, upper abdominal carcinomatosis, and ascites were identified as independent predictive factors for receiving NACT. PDS and NACT approaches showed comparable overall survival(OS), with a median OS of 34 versus 26 months(p=0.120), even in patients with extra-abdominal metastasis(p=0.796). Similar results were observed for patients with upper abdominal disease (median OS 28 versus 26 months, respectively, p=0.092). Multivariate analysis identified extra-pelvic peritoneal location of disease (HR: 1.844, CI: 1.129–3.013, p=0.015) and residual tumor (HR: 1.778, CI: 1.058–2.987, p=0.030) as independent poor prognostic factors for OS. Conclusion NACT followed by IDS is a viable treatment alternative for unresectable stage IVB EC. Extra-abdominal metastasis should not preclude surgical cytoreduction. Post-operative residual tumor and extra-pelvic carcinomatosis significantly impact survival. Disclosures Nothing to disclose.
Loverro et al. (Fri,) studied this question.