Quantifying the risk of recurrence and death in stage III (FIGO 2009) endometrial cancer
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.
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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.
References (16)
- et al.
Carcinoma of the corpus uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer
Int J Gynaecol Obstet
(2006) - et al.
Adjuvant treatment for stage IIIC endometrial cancer: options and controversies
Gynecol Oncol
(2011) - et al.
Positive peritoneal cytology in endometrial cancer: enhancement of other prognostic indicators
Gynecol Oncol
(2001) - et al.
Evaluating the significance of location of lymph node metastasis and extranodal disease in women with stage IIIC endometrial cancer
Gynecol Oncol
(2011) - et al.
Classification and regression tree (CART) analysis of endometrial carcinoma: seeing the forest for the trees
Gynecol Oncol
(2013) - et al.
Comparative outcomes assessment of uterine grade 3 endometrioid, serous, and clear cell carcinomas
Gynecol Oncol
(2013) - et al.
Should grade 3 endometrioid endometrial carcinoma be considered a type 2 cancer—a clinical and pathological evaluation
Gynecol Oncol
(2012) - et al.
Is there a difference in outcome between stage I–II endometrial cancer of papillary serous/clear cell and endometrioid FIGO Grade 3 cancer?
Int J Radiat Oncol Biol Phys
(2002)