title: FIGO stage IIIC endometrial carcinoma: resection of macroscopic nodal disease and other determinants of survival.
abstract: The objective of this study was to evaluate the potential survival benefit of debulking macroscopic adenopathy and other clinical prognostic factors among patients with node-positive endometrial carcinoma. Demographic, operative, pathologic, and follow-up data were abstracted retrospectively for 41 eligible patients with FIGO stage IIIC endometrial cancer. Survival curves were generated using the Kaplan-Meier method and statistical comparisons were performed using the log rank test, logistic regression analysis, and the Cox proportional hazards regression model. All patients had positive pelvic lymph nodes and 20 patients (48.8%) had positive para-aortic lymph nodes. Postoperatively, all patients received whole pelvic radiation therapy, 17 received extended-field radiation therapy, and 15 patients received chemotherapy. The median disease-specific survival (DSS) time for all patients was 30.6 months (median follow-up 34. 0 months). Patients with completely resected macroscopic lymphadenopathy had a significantly longer median DSS time (37.5 months), compared to patients left with gross residual nodal disease (8.8 months, P = 0.006). On multivariate analysis, independent predictors of DSS were gross residual nodal disease (HR 7.96, 95% CI 2.54-24.97, P < 0. 001), age > or = 65 years (HR 6.22, 95% CI 2.05-18.87, P = 0.001), and the administration of adjuvant chemotherapy (HR 0.22, 95% CI 0.07-0.76, P = 0.016). We conclude that in patients with stage IIIC endometrial carcinoma, complete resection of macroscopic nodal disease and the administration of adjuvant chemotherapy, in addition to directed radiation therapy, are associated with improved survival.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland. rbristo@jhmi.edu
authors.forename: R E
authors.initials: RE
authors.lastname: Bristow
authors.forename: M L
authors.initials: ML
authors.lastname: Zahurak
authors.forename: C J
authors.initials: CJ
authors.lastname: Alexander
authors.forename: R C
authors.initials: RC
authors.lastname: Zellars
authors.forename: F J
authors.initials: FJ
authors.lastname: Montz
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic; D018269:Carcinoma, Endometrioid / Q000401:mortality / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010388:Pelvis; D016016:Proportional Hazards Models; D016019:Survival Analysis