Significance of true surgical pathologic staging: A gynecologic oncology group study

OBJECTIVE: The object of the study was to determine the true surgical patho logic disease extent in patients with clinical stage II adenocarcinoma of t he endometrium. STUDY DESIGN: As part of a Gynecologic Oncology Group surgical pathologic p rotocol of patients with adenocarcinoma of the endometrium, patients with c linical stage II cancers were evaluated. Among >1000 patients with early st age disease entered into this protocol group study, 148 were in clinical st age II. All patients underwent abdominal hysterectomy bilateral salpingo-oo phorectomy, and selective pelvic and paraaortic lymphadenectomy as the prim ary therapy. Surgical pathologic material was evaluated to determine true e xtent of disease. RESULTS: Only 66 of 148 (45%) of patients in clinical stage II had cancer i n the cervix. Fifty-seven patients had disease limited to the upper fundus and 25 had disease extending into the lower uterine segment but not into th e cervix. Among the 66 patients with disease in the cervix, only 35 had dis ease limited to the uterus whereas 31 patients had extrauterine disease (ly mph nodes, adnexa, etc). Thus among 148 patients with diagnoses of clinical stage II disease only 35 (24%) in fact had true surgical stage II cancer. CONCLUSION: Clinical diagnosis of stage II adenocarcinoma of the uterus is a poor reflection of true surgical stage II cancer. Only when true extent o f disease is known can optimally definitive therapy be determined.