Prognostic determinants in patients with stage I uterine papillary serous carcinoma: a 15-year multi-institutional review.

Abstract

OBJECTIVE:

The aim of this retrospective, multi-institutional study was to evaluate the importance of surgical staging for stage I uterine papillary serous carcinomas (UPSCs) to determine optimal management of this rare tumor.

METHODS:

With institutional review board approval from both participating institutions, all patients with 2009 International Federation of Gynecology and Obstetrics stage I mixed serous and UPSC diagnosed between January 1, 1992, and December 31, 2007, were identified at the 2 institutions. Clinical factors were correlated using Spearman correlation coefficients, Kaplan-Meier survival estimates and a Cox proportional hazards model.

RESULTS:

Of the 204 UPSC patients treated during this period, 84 were classified as stage I, with substages as follows: stage IA, n = 71; stage IB, n = 13. Thirty-seven patients (44%) had a history of a second cancer (22 breast tumors, 9 synchronous müllerian cancers). Surgical staging with at least hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and bilateral pelvic lymph node dissection was performed in 60 (71%) of 84 patients. The median survival for all patients was 10 years. Univariate analysis revealed surgical staging (P < 0.001), normal preoperative CA-125 (P < 0.001), and absence of additional cancers (P < 0.01) to be associated with improved survival. Age-adjusted multivariate analysis incorporating these factors revealed that advancing substage (hazard ratio, 4.59; P < 0.05), a second malignancy (hazard ratio, 2.75; P < 0.04), and surgical staging (hazard ratio, 0.18; P < 0.001) were independent factors associated with overall survival. In a subset analysis excluding patients with a second malignancy, substage (hazard ratio, 3.52; P < 0.05), and surgical staging (hazard ratio, 0.16; P < 0.001) were independent factors affecting overall survival.

CONCLUSIONS:

Independent of adjuvant chemotherapy or radiation, stage of disease, comprehensive surgical staging, and the presence of a second malignancy were predictors of overall survival.

• Authors: Whitfield B Growdon, J Jose A Rauh-Hain, Adriana Cordon, Leslie Garrett, John O Schorge, Annekathryn Goodman, David M Boruta, Neil S Horowitz, Marcela G del Carmen
• Journal: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society (Int J Gynecol Cancer) Vol. 22 Issue 3 Pg. 417-24 (Mar 2012) ISSN: 1525-1438 [Electronic] England
• PMID: 22237383 (Publication Type: Evaluation Study, Journal Article, Multicenter Study)

Topics

• Aged
• Aged, 80 and over
• Carcinoma, Papillary (diagnosis, mortality, pathology, therapy)
• Chemotherapy, Adjuvant
• Combined Modality Therapy
• Female
• Gynecologic Surgical Procedures
• Humans
• Middle Aged
• Neoplasm Staging
• Neoplasms, Cystic, Mucinous, and Serous (diagnosis, mortality, pathology, therapy)
• Prognosis
• Radiotherapy, Adjuvant
• Retrospective Studies
• Survival Analysis
• Time Factors
• Uterine Neoplasms (diagnosis, mortality, pathology, therapy)