OBJECTIVE: The clinical significance and optimal management of patients with stage IIIA endometrial cancer are controversial. We sought to determine whether recurrence and survival of patients with stage IIIA endometrial cancer differ with surgical pathologic findings (positive peritoneal cytology versus positive adnexae or serosa) and adjuvant treatment. METHODS: Retrospective single institution analysis of patients surgically staged for IIIA endometrial cancer at Duke University Medical Center from 1973 to 2002. Stage IIIA patients were stratified into positive cytology alone (group IIIA1, n=37) and positive adnexae or uterine serosa (group IIIA2, n=20). Comparison was made with previously reported group of 467 patients with surgical stage I/II disease. Recurrence and survival were analyzed using Kaplan-Meier estimations and Cox proportional hazards model. RESULTS: Mean age of 57 patients with stage IIIA endometrial cancer was 63. Adjuvant therapies were administered to 89% patients (74% radiotherapy, 4% chemotherapy, 19% progestins). Five-year overall (OS) and recurrence-free disease-specific survival (RFDSS) were 64% and 76%, respectively. Survival was similar comparing IIIA1 (62%) and IIIA2 (68%, p=0.999). RFDSS by adjuvant therapy was: external beam radiotherapy 89% (n=10), intraperitoneal P32 84% (n=21), progestins 78% (n=9), none 75% (n=6). 61% recurrences included extrapelvic component. In multivariable analysis of stage I-IIIA patients (n=517), positive cytology but not adnexal/serosal metastasis was predictive of death (HR 1.70, 95% CI 1.06-2.73) and disease recurrence (HR 1.70, 95% CI 1.07-2.71). CONCLUSION: Among patients with stage IIIA endometrial cancer, metastasis to adnexae or serosa does not appear to confer worse prognosis than positive cytology alone. Positive cytology is an independent predictor of prognosis among patients with stage I-IIIA endometrial cancer. While optimal adjuvant therapy for these groups remains unclear, recurrence patterns suggest that systemic therapies are appropriate.
OBJECTIVE: The clinical significance and optimal management of patients with stage IIIA endometrial cancer are controversial. We sought to determine whether recurrence and survival of patients with stage IIIA endometrial cancer differ with surgical pathologic findings (positive peritoneal cytology versus positive adnexae or serosa) and adjuvant treatment. METHODS: Retrospective single institution analysis of patients surgically staged for IIIA endometrial cancer at Duke University Medical Center from 1973 to 2002. Stage IIIA patients were stratified into positive cytology alone (group IIIA1, n=37) and positive adnexae or uterine serosa (group IIIA2, n=20). Comparison was made with previously reported group of 467 patients with surgical stage I/II disease. Recurrence and survival were analyzed using Kaplan-Meier estimations and Cox proportional hazards model. RESULTS: Mean age of 57 patients with stage IIIA endometrial cancer was 63. Adjuvant therapies were administered to 89% patients (74% radiotherapy, 4% chemotherapy, 19% progestins). Five-year overall (OS) and recurrence-free disease-specific survival (RFDSS) were 64% and 76%, respectively. Survival was similar comparing IIIA1 (62%) and IIIA2 (68%, p=0.999). RFDSS by adjuvant therapy was: external beam radiotherapy 89% (n=10), intraperitoneal P32 84% (n=21), progestins 78% (n=9), none 75% (n=6). 61% recurrences included extrapelvic component. In multivariable analysis of stage I-IIIA patients (n=517), positive cytology but not adnexal/serosal metastasis was predictive of death (HR 1.70, 95% CI 1.06-2.73) and disease recurrence (HR 1.70, 95% CI 1.07-2.71). CONCLUSION: Among patients with stage IIIA endometrial cancer, metastasis to adnexae or serosa does not appear to confer worse prognosis than positive cytology alone. Positive cytology is an independent predictor of prognosis among patients with stage I-IIIA endometrial cancer. While optimal adjuvant therapy for these groups remains unclear, recurrence patterns suggest that systemic therapies are appropriate.
Authors: Daniela Matei; Virginia Filiaci; Marcus E Randall; David Mutch; Margaret M Steinhoff; Paul A DiSilvestro; Katherine M Moxley; Yong M Kim; Matthew A Powell; David M O'Malley; Nick M Spirtos; William Small; Krishnansu S Tewari; William E Richards; John Nakayama; Ursula A Matulonis; Helen Q Huang; David S Miller Journal: N Engl J Med Date: 2019-06-13 Impact factor: 91.245
Authors: Koji Matsuo; Shinya Matsuzaki; David J Nusbaum; Hiroko Machida; Yoshikazu Nagase; Brendan H Grubbs; Lynda D Roman; Jason D Wright; Philipp Harter; Maximilian Klar Journal: Eur J Cancer Date: 2020-05-17 Impact factor: 9.162
Authors: Gunjal Garg; Feng Gao; Jason D Wright; Andrea R Hagemann; David G Mutch; Matthew A Powell Journal: Gynecol Oncol Date: 2012-09-29 Impact factor: 5.482
Authors: Koji Matsuo; David J Nusbaum; Shinya Matsuzaki; Erica J Chang; Lynda D Roman; Jason D Wright; Philipp Harter; Maximilian Klar Journal: Gynecol Oncol Date: 2020-07-18 Impact factor: 5.482
Authors: Gunjal Garg; Feng Gao; Jason D Wright; Andrea R Hagemann; Israel Zighelboim; David G Mutch; Matthew A Powell Journal: Int J Gynecol Cancer Date: 2013-01 Impact factor: 3.437
Authors: Jan J Jobsen; Lambert Naudin Ten Cate; Marnix L M Lybeert; Astrid Scholten; Elzbieta M van der Steen-Banasik; Job van der Palen; Marika C Stenfert Kroese; Annerie Slot; Eltjo M J Schutter; Sabine Siesling Journal: Obstet Gynecol Int Date: 2011-05-04