Uterine Papillary Serous Carcinoma: Evaluation of Long-Term Survival in Surgically Staged Patients

Virginia Mason Medical Center, Seattle, Washington, United States
Gynecologic Oncology (Impact Factor: 3.69). 05/1998; 69(1):69-73. DOI: 10.1006/gyno.1998.4956
Source: PubMed

ABSTRACT Earlier studies have demonstrated that the uterine papillary serous carcinoma (UPSC) variant of endometrial carcinoma has a high recurrence rate, even when disease is apparently confined to the uterus. The current study evaluated survival in patients with surgically staged UPSC.
Patients with UPSC were identified from surgical pathology files and charts were retrospectively reviewed. Only patients who had undergone a TAH-BSO, lymph node dissection, and peritoneal cytology were included.
The FIGO stages of the 36 patients were 12 Stage I (4 IA, 4 IB, 4 IC), 2 Stage IIB, 13 Stage III (5 IIIA, 8 IIIC), and 9 Stage IV. Of the 14 Stage I/II patients, 6 did not receive adjuvant therapy, 5 received whole pelvic radiation (WPXRT), and 3 received whole abdominal radiation therapy (WART); after a median follow-up interval of 50 months only 2 (14%) of these Stage I/II patients have developed a recurrence. Both of the recurrences were in Stage IC patients who received radiation; 1 recurred in the radiation field. Of the 5 Stage IIIA patients, 3 patients declined therapy and 2 were treated with WART; 3 patients, including the 2 who received radiation therapy, are alive without disease. Of the 8 Stage IIIC patients, 2 declined postoperative therapy, 2 received WART, and 4 received WPXRT with an extended field to include paraaortic nodes. Four of the 6 Stage IIIC patients treated with curative intent are without evidence of disease and 1 died of unrelated causes after a median follow-up interval of 48 months. Both of the Stage IIIC patients who declined treatment recurred. Of the 9 patients with Stage IV disease, 8 have died of disease.
Women with UPSC have a good prognosis when surgical staging confirms that disease is confined to the uterus (Stage I/II). Surgical findings can also be used to tailor adjuvant radiation treatments. Further study is required to define the optimal treatment for women with metastatic UPSC.

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    • "For those with disease confined to the endometrium after complete surgical staging, surveillance alone appears to be appropriate . Our 10% recurrence rate among those with Stage IA MI− who did not receive adjuvant therapy is comparable to most other reported series [8] [9] [10] [11]. In contrast, Mahdavi et al., Slomovitz et al., and Kelly et al. reported higher rates of recurrence (30%, 21%, and 29%, respectively ) in the absence of adjuvant therapy [12] [13] [14]. "
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    ABSTRACT: Uterine serous carcinoma (USC) is a rare type of endometrial cancer that often recurs in patients with Stage I disease. Our objective was to evaluate treatment and outcomes in Stage I USC in the context of a population-based study. This was a population-based retrospective cohort study of all patients with Stage I USC in British Columbia, Canada from 2004-2012. The British Columbia Cancer Agency (BCCA) recommends three cycles of paclitaxel and carboplatin chemotherapy followed by pelvic radiotherapy for all women with Stage I USC and any myometrial invasion (Stage IA MI-). If no myometrial invasion (Stage IA MI-), no postoperative treatment is given. Patient and disease characteristics, surgery, adjuvant therapy, recurrence rates and sites, and 5-year disease-free survival rates were evaluated. Of the 127 patients with Stage I USC, 41 were Stage IA MI-, 56 Stage IA MI+, and 30 Stage IB. Median follow-up was 25months (2-98months). Five year disease-free survival rates were 80.7%, 74.4%, and 48.5% for Stage IA MI-, IA MI+, and IB, respectively, and recurrence rates according to BCCA guidelines were 10%, 2.9% and 30%. Of the 18 with recurrences, 13 had a distant component (72.2%). There were no pelvic recurrences among those receiving adjuvant radiotherapy. Our current protocol of observation alone postoperatively for Stage IA MI- and chemoradiotherapy for Stage IA MI+is associated with a low recurrence rate. In contrast, those with Stage IB USC have a higher recurrence rate despite chemoradiotherapy, and likely require alternate treatment strategies.
    Gynecologic Oncology 11/2013; DOI:10.1016/j.ygyno.2013.11.002 · 3.69 Impact Factor
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    • "However, most patients did not undergo surgical evaluation of regional lymph nodes in such studies. On the other hand, some studies reported that the 5-year survival rates were more than 80% in FIGO stages I–II uterine papillary serous carcinoma confirmed by surgical evaluation of lymph nodes [14] [15]. "
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    ABSTRACT: OBJECTIVE: This study aimed to clarify the clinical significance of tumor volume in endometrial cancer. METHODS: A total of 667 patients with endometrial cancer who underwent preoperative MRI and surgical treatment including lymphadenectomy were enrolled. As the surrogate marker of actual tumor volume, the volume index was defined as the product of the maximum longitudinal diameter along the uterine axis, the maximum intersecting anteroposterior diameter of the sagittal section image, and the maximum horizontal diameter of the horizontal section image from the MRI data. The volume index was divided into five categories: Group 1 (< 8), Group 2 (8 to < 27), Group 3 (27 to < 64), Group 4 (64 to < 125), and Group 5 (125 or more). The relationships between various clinicopathologic factors and volume index were investigated, and Cox regression analysis was conducted to assess the significance of volume index with respect to prognosis. RESULTS: High-risk clinicopathologic findings increased with tumor volume. The lymph node metastasis rate was 3% in Group 1, 9% in Group 2, 17% in Group 3, 25% in Group 4, and 53% in Group 5. Cox regression analysis showed that the volume index (≥36) was a prognostic factor (hazard ratio: 2.0, 95% confidence interval: 1.3-3.1) independent of older age (≥58 years), high-risk histological grade/subtype, deep myoinvasion, lymph node metastasis, and type of surgery. CONCLUSION: Tumor volume successively reflects the state of disease progression in endometrial cancer. The volume index can give information on both the staged prognosis and surgical management.
    Gynecologic Oncology 03/2013; 129(3). DOI:10.1016/j.ygyno.2013.02.034 · 3.69 Impact Factor
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    • "In contrast, data from our prior report and the current study suggest that these histopathologic factors might have a prognostic value in this patient population [34]. Further variables including age at diagnosis, stage of disease and surgical treatment have been shown to impact outcome of USC patients as well [38] [39] [40]. "
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    ABSTRACT: OBJECTIVE: Uterine serous carcinoma (USC) constitutes 10% of uterine cancers but ~40% of deaths. Tumor size is a known prognostic factor in other solid tumors. In endometriod cancers it is one element used to identify the need for complete staging, while its significance in USC is debated. Therefore tumor size was examined as an independent prognostic factor. METHODS: Clinical and pathologic variables were recorded for 236 institutional patients, and those patients in the SEER database with USC. Chi-square and Fisher exact t-tests were utilized and survival data generated via Kaplan Meier method; multivariate analysis was performed via cox-regression. RESULTS: The patients' mean age was 67.2years (range 40-91). Survival ranged from 0-184months (mean 42.8). We used a tumor size cut-off of 1cm and noted significant associations with myometrial invasion (p <0.0001), angiolymphatic invasion (p <0.0001), peritoneal washings (p=0.03), stage (p =0.015) and positive lymph nodes (p=0.05). Furthermore, recurrence was associated with larger tumors (p=0.03). In multivariate analysis, extra-uterine disease was the only factor associated with both recurrence and survival. Review of the SEER database noted association of larger tumors with lymph node involvement and a significant survival advantage with tumors <1cm in both univariate and multivariate analysis. Conclusions Treatment options for USC are often predicated on the surgical stage and therefore components of the staging are vitally important. The 1cm tumor-size cut-off should be studied prospectively as a prognostic indicator of survival and recurrence in USC and considered for inclusion in USC staging.
    Gynecologic Oncology 11/2012; DOI:10.1016/j.ygyno.2012.10.027 · 3.69 Impact Factor
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