Hematogenous dissemination in corpus cancer

Objective. The aim of this study was to assess the predictors of hematogeno us dissemination (HD) in corpus cancer. Methods. In 612 corpus cancer patients managed surgically, we defined HD as tumor spread to the lung, liver, or other sites via hematogenous routes. Results. We observed 142 instances of tumor spread-71 nonhematogenous and 4 2 hematogenous to the lung, 9 to the liver, 5 to other sites (adrenals, bre ast, brain, bone, skin), 3 to both liver and lung, 1 to both lung and bone, and 11 to sites unknown. Stage IV disease, positive adnexae, deep myometri al invasion, primary tumor diameter, tumor involving the whole uterine cavi ty, positive peritoneal cytology, adjuvant radiotherapy, adjuvant chemother apy, grade 3 histology, histologic subtype, and lymph-vascular invasion sig nificantly (P less than or equal to 0.01) correlated with HD. However, deep myometrial invasion was the only independent predictor of HD. Only 5% of p atients with less than or equal to 50% myometrial invasion had HD compared with 23% with >50% myometrial invasion. Considering separately recurrence i n the lung and in the liver and recurrence in other sites, the only indepen dent predictors of lung recurrence were stage IV disease and myometrial inv asion, whereas independent predictors of HD to the liver/other sites were a ge and histologic grade. Considering only the 60 patients with a known site of HD, 67% with lung recurrence were >65 years old compared with 17% with HD to the liver/other sites. Furthermore, grade 1-2 disease was observed in 65% of patients with lung recurrence compared with 27% with HD to the live r/other sites. Conclusions. The presence of deep myometrial invasion was the strongest pre dictor of HD in corpus cancer, and, together with stage IV disease, it inde pendently predicted lung recurrence. Recurrence in the lung was more freque nt in older patients with well or moderately differentiated tumors, whereas HD to the liver/other sites was more frequent in patients less than or equ al to 65 years of age harboring grade 3 tumors. (C) 2001 Academic Press.