Stage III endometrial cancer: Analysis of prognostic factors and failure patterns after adjuvant chemotherapy

Objective. This study was performed to assess the prognostic factors and pa tterns of recurrence in stage III endometrial carcinoma treated with surger y and adjuvant chemotherapy. Methods. A retrospective review of 61 stage III endometrial carcinoma patie nts treated between 1988 and 1998 at Niigata University Hospital was perfor med. All patients underwent surgery, followed by adjuvant chemotherapy cons isting of intravenous cisplatin, doxorubicin, and cyclophosphamide. Multiva riate analysis was performed for the prognostic factors and actuarial techn iques were used for the survival and recurrence rates. Results. The 5-year disease-free survival was 78.6%. Multivariate analysis revealed deep myometrial invasion and lymph-vascular space involvement corr elated significantly with disease-free survival. Based on these two factors , the patients could be divided into low-risk and high-risk groups. The 5-y ear disease-free survival for the low-risk group was 100%, which was signif icantly better than the 59.1% for the high-risk group. Disease recurrence o ccurred in 13 of 30 high-risk patients, and there was no recurrence in the 31 low-risk patients. Looking at the patterns of recurrence for the high-ri sk group by lymph node metastasis, 5 recurrences were locoregional, 1 was l ocoregional/distant, and 1 was distant in 16 node-positive high-risk patien ts. In 14 node-negative patients, 5 had distant and 1 had locoregional/dist ant recurrences. Conclusions. The locoregional failure in the node-positive highrisk group d eserves further attention. For improvement of locoregional control, it may be worthwhile to consider new strategies. The role of new adjuvant chemothe rapy should be investigated to control distant failure in node-negative hig h-risk patients. (C) 2001 Academic Press.