Extended surgical staging for uterine papillary serous carcinoma: Survivaloutcome of locoregional (Stage I-III) disease

Objective. The aim of this study was to evaluate survival outcome in patien ts with locoregional uterine papillary serous carcinoma (UPSC) after extend ed surgical staging (ESS). Methods. Ail patients diagnosed with FIGO Stage I-III UPSC undergoing ESS ( vertical incision, peritoneal cytology, TAH/BSO, omental biopsy, lymph node sampling, peritoneal biopsy) between 1/1/89 and 12/31/98 ware identified r etrospectively from the tumor registry database. Pathologic features predic tive of regional extrauterine spread were evaluated using the log-rank test . The Kaplan-Meier method was used to generate survival curves, and median survival determinations were compared using the log-rank test or the propor tional hazards regression model. Results. Twenty-six patients with locoregional UPSC were identified: FIGO S tage I(n = 11), Stage II(n = 7), and Stage III(n = 8). The median age at di agnosis was 66 years. Preoperative endometrial pathology correctly identifi ed the presence of UPSC in 76.9% of cases. The only pathologic feature foun d to be predictive of regional extrauterine spread (Stage III) was myometri al invasion greater than or equal to 50% (P = 0.028), Adjuvant radiation th erapy (RT) was administered to 6/18 patients with Stage I/II disease and 5/ 8 patients with Stage III disease. Platinum-based chemotherapy was administ ered to 5 patients with Stage III disease. Ail recurrences of Stage I/II di sease were located within the pelvis (16.7%), For Stage III disease, all re currences occurred at distant sites (42.9%). The median follow-up time for surviving patients was 39.0 months (mean = 45.0 months). For all patients, the overall 5-year survival rate was 61.2%, According to FIGO stage, the ov erall 5-year survival rates were Stage I, 81.8%; Stage II, 64.3%; and Stage III, 31.3%. No significant differences were detected in the risk of death by stage, although there was a trend toward worse survival with Stage III d isease: Stage I hazard ratio [HR] = 1.00, Stage II HR = 1.68, 95% confidenc e interval [CI] = 0.23-12.03, Stage III HR = 3.63, 95% CI = 0.65-20.12, Conclusions. Patients with locoregional UPSC following ESS have a more favo rable prognosis than previously thought. The additional information provide d by ESS facilitates the selection of adjuvant therapy. Whole pelvic RT is recommended for patients with Stage I/II disease. Pathologic Stage III dise ase portends a significant risk of distant recurrence. For these patients, administration of adjuvant chemotherapy should be considered in addition to directed RT. (C) 2001 Academic Press.