Stage IVB endometrial carcinoma: The role of cytoreductive surgery and determinants of survival

Objective. The aim of this study was to evaluate the role of cytoreductive surgery and survival determinants in patients with Stage IVB endometrial ca rcinoma. Methods. All patients with Stage IVB endometrial carcinoma diagnosed betwee n 1/1/90 and 12/31/98 were identified from tumor registry databases. Indivi dual patient data were collected retrospectively. Survival analyses and com parisons were performed using the Kaplan-Meier method and the log-rank test . The Cox proportional hazards model was used to identify independent varia bles associated with survival. Results. Sixty-five patients underwent surgery as primary therapy for Stage IVB endometrial carcinoma (median survival 14.8 months). The median age of the population was 65 years (range 29-85 years); 89.2% of patients were po stmenopausal, and 21.5% were nulliparous. The most common histologic subtyp es were endometrioid (33.8%), serous (32.3%), and mixed (16.9%). Optimal cy toreductive surgery (residual tumor less than or equal to 1 cm in maximal d iameter) was accomplished in 36 patients (55.4%), while 29 patients (44.6%) were left with >1 cm residual disease. The median survival rate of patient s undergoing optimal surgery was 34.3 months, a statistically significant a dvantage compared to patients with >1 cm residual tumor (11.0 months, P = 0 .0001). Among those with optimal surgery, patients with only microscopic re sidual disease survived significantly longer than patients with optimal but macroscopic residual tumor. Higher performance status, age less than or eq ual to 58 years, and adjuvant chemotherapy followed by radiation therapy we re also significantly associated with superior survival on univariate analy sis. On multivariate analysis, residual disease (P = 0.0001), performance s tatus (P = 0.043), and age (P = 0.023) were independent predictors of survi val. Conclusions. The amount of residual disease after cytoreductive surgery, ag e, and performance status appear to be important determinants of survival i n patients with Stage IVB endometrial carcinoma. Maximal cytoreduction shou ld be the goal at the time of primary surgery for advanced disease. For sel ected patients, combined postoperative chemotherapy and radiation therapy m ay provide some therapeutic benefit. (C) 2000 Academic Press.