Early stage uterine papillary serous carcinoma of the endometrium - Effectof adjuvant whole abdominal radiotherapy and pathologic parameters on outcome

BACKGROUND, Uterine papillary serous carcinoma (UPSC) is an aggressive subt ype of endometrial cancer, behaving like ovarian epithelial cancers and hav ing a predilection for transperitoneal relapse. Within this subtype of uter ine cancers, predictors of outcome and the role of adjuvant therapies have not been firmly established, to the authors' knowledge.. METHODS. Between 1985-1995, 78 patients who had International Federation of Gynecology and Obstetrics (FIGO) Stage I, II, or III UPSC (based on positi ve washings only) were seen at the British Columbia Cancer Agency. During t his time, the authors had a policy of offering adjuvant pelvic, paraaortic and whole-abdominal radiotherapy (WART) to these patients. Fifty-eight pati ents received adjuvant WART, and 20 received lesser or no adjuvant therapy. The authors undertook a retrospective analysis of pathology with quantific ation of the percentage of papillary serous component (% PSC) and p53 expre ssion. Pathology was retrieved and reviewed on 62 patients; p53 staining wa s performed on blocks from the hysterectomy specimen in 46 cases. Pathologi c parameters, stage, and adjuvant therapy were correlated with clinical out come in a multivariate analysis. RESULTS. Median follow-up tvas 52 months (3-139 mos) and the 5-year disease -specific survival rate was 66.2%. The 58 patients who received adjuvant WA RT had a significantly better 5-year disease-specific survival than those 2 0 patients who did not, 74.9% versus 41.3% (P = 0.04). Multivariate analysi s showed that % PSC and p53 were not significant predictors of outcome for early stage UPSC. Of the factors examined, only FIGO stage and WART signifi cantly predicted improved outcome (P = 0.02 and 0.04, respectively). CONCLUSIONS. The current study demonstrated a significant difference in the outcomes of patients who had FIGO Stage I compared with Stage II UPSC. In the current series of patients, the authors were not able to predict outcom e based on % PSC or p53 expression. The current study results with WART wer e promising, and WART merits further study. (C) 2001 American Cancer Societ y.