Survival impact of adjuvant chemotherapy after pelvic exenteration for gynecologic cancers: secondary analysis of COREPEX

The multinational, retrospective Complications and Recurrence after Pelvic Exenteration (COREPEX) study reported prognostic factors affecting survival in patients undergoing pelvic exenteration for gynecologic cancer. Secondary analysis of COREPEX investigating the survival impact of adjuvant chemotherapy after pelvic exenteration in patients with pelvic lymph node metastasis has now been published. Inclusion criteria were cervical, vaginal, vulvar, or endometrial cancer; with anterior or total pelvic exenteration performed between 2005 and 2023 with curative or palliative intent. Data from 121 patients were retrieved: 49 (40.5%) received adjuvant chemotherapy (median 6 cycles; range 1-15; most frequently carboplatin and paclitaxel) and 72 (59.5%) did not. The median follow-up time was 57.0 months. The figure shows survival outcomes. Patients undergoing adjuvant chemotherapy had significantly better disease-free survival, overall survival, and cancer-specific survival, compared with patients not undergoing adjuvant chemotherapy. Multivariable analysis showed that the use of adjuvant chemotherapy was the only factor independently associated with improved disease-free survival (HR 0.44; 95% CI 0.27-0.71) and overall survival (0.39; 0.23-0.66). The authors conclude that administration of adjuvant chemotherapy was associated with improved survival in patients undergoing pelvic exenteration for gynecological cancer with metastatic lymph nodes.