The role of cytoreductive surgery in the management of stage IV uterine papillary serous carcinoma

Objective. The aim of this study was to evaluate the survival impact of cyt oreductive surgery and other prognostic determinants in patients with Stage IV uterine papillary serous carcinoma (UPSC). Methods. All patients with PICO Stage IV UPSC diagnosed between January 1, 1989 and December 31, 1998 were identified from tumor registry databases. I ndividual patient data were collected retrospectively. Survival analysis an d comparisons were performed using the method of Kaplan and Meier, the log- rank test, and the Cox proportional hazards regression model. Predictors of surgical outcome were evaluated using the log-rank test. Results. Thirty-one patients underwent primary cytoreductive surgery for St age IV UPSC (median age, 65 years). The median survival for all patients wa s 14.4 months. Optimal cytoreduction was defined as residual disease less t han or equal to1 cm in maximal diameter. The only significant predictor of a suboptimal surgical outcome was the presence of disease in three or more anatomic regions. Overall, 16 of 31 patients (51.6%) completed primary surg ery with optimal disease status. Optimal cytoreduction was associated with a median survival of 26.2 months, compared with 9.6 months for patients lef t with suboptimal residual disease (P < 0.001). At 24 months, 57.1% of opti mally cytoreduced patients were still alive, compared with just 6.7% of pat ients left with suboptimal disease. Furthermore, patients with only microsc opic residual tumor had a significantly longer median survival (30.4 months ) than both patients with 0.1- to 1.0-cm residual disease (20.5 months) and those left with suboptimal disease (P = 0.004). Postoperative platinum-bas ed chemotherapy was associated with a median survival of 17.1 months, compa red with 9.5 months without such therapy (P = 0.018). Patients receiving th e combination of platinum + paclitaxel had a median survival rate of 29.1 m onths versus 14.4 months for patients receiving platinum + cyclophosphamide +/- doxorubicin (P = 0.054). On multivariate analysis, the only statistica lly significant predictor of survival was the cytoreductive surgical outcom e. Conclusions. The strongest predictor of overall survival for patients with Stage IV UPSC was the amount of residual disease following surgery. Recomme nded management for this group of patients should consist of maximal surgic al cytoreduction followed by platinum-based chemotherapy, preferably in com bination with paclitaxel. (C) 2001 Academic Press.