Delayed Initiation of Postoperative Chemotherapy and Survival in Endometrial Cancer

Each additional month between surgery and chemotherapy initiation increases the risk of recurrence or death by 65% in patients with endometrial cancer, according to a recent retrospective cohort study presented at the Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer in Seattle, WA. While unadjusted analysis did not show a significant association between time to chemotherapy (TTC) and survival outcomes, multivariable modeling revealed a statistically significant relationship between longer TTC and worse progression-free survival (PFS).

The study assessed whether delays in initiating postoperative chemotherapy impacts survival outcomes in patients with endometrial cancer. Optimizing surgical and postoperative management is increasingly recognized as critical for improving long-term outcomes, yet the effect of TTC on survival remains unclear.

This retrospective cohort study included patients with endometrial cancer who underwent primary surgical management and subsequent chemotherapy at an urban academic institution between January 2014 and October 2023. Patients who received neoadjuvant chemotherapy were excluded. Clinical-pathologic data and follow-up outcomes were extracted from medical records. Kaplan-Meier survival analysis and Cox regression models were used to assess the relationship between TTC and survival outcomes while adjusting for covariates, including year and age at surgery, race, International Federation of Gynecology and Obstetrics stage, histology, and insurance status. The t test was used to compare TTC across demographic and clinical subgroups.

Among 1027 patients who underwent primary surgical management during the study period, 249 received adjuvant chemotherapy. The median follow-up was 37 months (range, 1.4–119.2 months). When TTC was categorized into four intervals (0–28, 29–42, 43–56, and ≥57 days), univariable analysis found no statistically significant association between TTC and PFS or overall survival (OS). However, in the adjusted multivariable model, longer TTC was significantly associated with worse PFS (hazard ratio = 1.65; 95% CI, 1.03–2.65). Race, insurance status, and age at surgery were not associated with differences in PFS or TTC. Additionally, no significant differences in TTC were observed based on race, insurance status, age, BMI, disease stage, or surgical technique.

“In our cohort, each additional month between surgery and chemotherapy initiation increased the risk of recurrence or death by 65% in patients with endometrial cancer,” the authors concluded. “The importance of optimizing surgical outcomes through minimally invasive approaches and enhanced recovery after surgery extends beyond length of stay and complication rates.”

Reference

Cox M. Impact of delayed initiation of postoperative chemotherapy in patients with endometrial cancer. Paper presented at: Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer; March 14-17, 2025; Seattle, WA. Accessed March 11, 2025. https://www.sgo.org/events/annual-meeting/