PROGNOSTIC FACTORS IN SURGICAL STAGE-III AND STAGE-IV CARCINOMA OF THE ENDOMETRIUM

Objective: To identify prognostic factors in surgical stage III and TV endometrial carcinoma. Methods: We performed a retrospective analysis of 58 cases of stage III and IV endometrial cancer using the Cox prop ortional hazards model. Results: Extrapelvic peritoneal metastases and positive peritoneal cytology greatly affected survival. If either of these factors was present, the 2-year survival rate was only 25%, wher eas if they were absent, it was 82%. All patients with extrapelvic met astases died of their disease despite systemic therapy, as did ten of 13 patients with positive peritoneal cytology. Although postoperative therapy in these patients varied, it had no obvious effect on survival or on the site of recurrence. In the absence of abdominal disease or positive peritoneal cytology, survival was not influenced significantl y by the presence or absence of lymph node metastases. The difference in survival between women with aortic and pelvic lymph node metastases (24% at 5 years) was not significant, but the power to detect this di fference was low (35%). Stage affected survival significantly (P < .05 ), but a two-category variable, indexing patients as having either pos itive peritoneal cytology or abdominal disease, provided a much better fit and a more parsimonious model for the data. Conclusion: Five-year survival rates exceeding 70% can be achieved in endometrial carcinoma even if extrauterine disease is present, provided that peritoneal cyt ology is negative and abdominal metastases are absent.