Results of therapy, analysis of failures, and prognostic factors for clinical and pathologic stage III adenocarcinoma of the endometrium.

A retrospective analysis was performed on 427 patients with clinical stage I, II, and III adenocarcinoma of the endometrium treated definitively with total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) and pre- or postoperative irradiation at our institution from January 1960 through December 1981. Of 310 patients with clinical stage I, 21 (6.8%) and 9 of 90 (10%) clinical stage II patients were found to have pathologic stage III (CS I-II/PS III) tumors. In addition, 27 patients had clinical stage III (CS III) tumors at the time of diagnosis. At 5 years the overall and disease-free survival for all patients with clinical and/or pathologic stage III disease was 43.5 and 46.2%, respectively. The 5-year disease-free survival for CS I/PS III was 67.3% compared to 32.6% for CS II/PS III and 33.4% for CS III. Failure to control the disease in the pelvis occurred in 14.3% of the CS I/PS III patients and in 44.4 and 33.3% of the CS II/PS III and CS III patients, respectively. The appearance of distant metastasis was higher with increasing stage (19.1% for CS I/PS III, 33.3% for CS II/PS III, and 48.1% for CS III). Eighty percent of all failures occurred within 40 months. Grade of the tumor was associated with increasing pathologic stage but not with ability to control the disease in the pelvis. However, there was a tendency for higher grade lesions to fail more often at distant sites.