Elsevier

Gynecologic Oncology

Volume 134, Issue 2, August 2014, Pages 297-301
Gynecologic Oncology

Quantifying the risk of recurrence and death in stage III (FIGO 2009) endometrial cancer

https://doi.org/10.1016/j.ygyno.2014.05.013Get rights and content

Highlights

  • Stage III endometrial cancer patients are heterogeneous and have varied prognoses.

  • High-grade histology, positive cytology, & myometrial invasion predict poor outcome.

  • These risk factors are more prognostically discriminating than FIGO subgroup.

Abstract

Objective

Advanced endometrial cancer patients comprise a heterogeneous group. This study assessed the association of clinicopathological factors with relapse and death from endometrial cancer.

Methods

Eligible patients were treated for stage III (FIGO 2009) endometrial adenocarcinoma, had peritoneal cytology performed, and had no gross residual disease post-operatively.

Results

Of 192 patients, 59% were ≥ 60 years old, 48% had ≥ 50% myometrial invasion, 71% lymphovascular invasion, 25% cervical stromal invasion, 37% adnexal involvement, and 23% positive peritoneal cytology. High-grade histology (serous, clear cell, undifferentiated, or grade 3 endometrioid) was present in 45%. Pelvic lymphadenectomy was performed in 93% and para-aortic lymphadenectomy in 73%. Adjuvant chemotherapy and/or radiation therapy was administered to 93%. At a median follow-up of 42 months, the 5-year rate of relapse was 37% and of death from endometrial cancer was 30%. On multivariate analysis, both outcomes were associated with high-grade histology, positive peritoneal cytology, and deep myometrial invasion (p  0.04). The cohort was divided into subgroups of patients with 0 (n = 46), 1 (n = 83), or ≥ 2 (n = 63) of these high-risk characteristics. The 5-year relapse rate for patients with 0 risk factors was 13%, 1 risk factor was 27%, and ≥ 2 risk factors was 62% (p < 0.001). The corresponding 5-year rates of death from endometrial cancer were 11%, 20%, and 56%, respectively (p < 0.001).

Conclusions

Stratification of stage III endometrial cancer according to high-grade histology, positive peritoneal cytology, and deep myometrial invasion is useful for prognostication and may grant insight into the optimal treatment for specific subgroups of patients.

Introduction

The reported outcomes of stage III endometrial cancer vary significantly. According to the 2006 FIGO annual report, the 5-year overall survival of stage III endometrial cancer patients ranges from 37 to 67% [1]. This disparity is a consequence of the heterogeneous clinical and pathological characteristics encompassed within stage III. A broad spectrum of patients is combined for the purpose of clinical trials, given the paucity of locally advanced endometrial cancer patients. However, combining diverse patients in this way may obscure prognostic differences between subgroups [2].

Distinguishing subgroups of patients with stage III endometrial cancer is important for several reasons. First, it facilitates comparisons of reported outcomes in stage III endometrial cancer, because study cohorts may have various baseline clinical and pathological characteristics that portend different prognoses. Additionally, it enables the clinician to identify individual patients who may benefit from intensification of treatment and those who may require less aggressive therapy. Furthermore, stage III patients with particular characteristics may experience distinct recurrence patterns, suggesting the possibility of tailoring adjuvant therapy to specific subgroups. The purpose of this study was to describe the association of clinical and pathological factors with the risk of relapse or cause-specific mortality in 192 stage III (FIGO 2009) endometrial cancer patients who were treated at a single institution.

Section snippets

Study design

After obtaining a waiver of authorization from the Institutional Review Board, stage III (FIGO 2009) endometrial cancer patients who underwent a total hysterectomy and bilateral salpingo-oophorectomy at a single institution from 1995 to 2009 were identified retrospectively. Inclusion criteria comprised the diagnosis of uterine adenocarcinoma and examination of peritoneal cytology at the time of definitive surgery. Patients were excluded if they had a diagnosis of uterine carcinosarcoma, had

Patient and disease characteristics

The median age at the time of surgery was 62 years (range 33–86). Of the 192 patients, 114 (59%) were ≥ 60 years old. In all cases, definitive surgery consisted of total hysterectomy, bilateral salpingo-oophorectomy, and peritoneal cytology. Pelvic lymphadenectomy was performed in 178 cases (93%; median 14 lymph nodes [LN] dissected; range 1–51 LN) and para-aortic lymphadenectomy in 140 cases (73%; median 6 LN dissected; range 1–34 LN). The histology was grade 1 or 2 endometrioid in 105 patients

Discussion

The results of this study demonstrate that three pathological factors — high-grade histology, positive peritoneal cytology, and deep myometrial invasion — strongly predict outcome in stage III endometrial cancer. Based on the number of these characteristics present, patients may be divided into groups that are highly predictive of prognosis. In this cohort of 192 stage III (FIGO 2009) patients, the 5-year rates of relapse increased from 13% for patients with no risk factors, to 27% for those

Conflict of interest statement

The authors declare that there are no conflicts of interest.

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