title: Does size matter? Tumor size and morphology as predictors of nodal status and recurrence in endometrial cancer.
abstract: OBJECTIVE
  To determine whether tumor size or morphology is predictive of extrauterine disease and/or recurrence risk in endometrial cancer and therefore guide decisions about the necessity of complete surgical staging and adjuvant therapy.
  
  
  METHODS
  All women with surgically treated endometrial carcinoma between 1 January 1990 and 1 January 2000 were eligible. 345 patients were eligible for retrospective chart review. Univariate and multivariate logistic regression models were used to determine the predictors of nodal metastasis and recurrence.
  
  
  RESULTS
  As tumor size increased, the risk of nodal metastasis increased. However, a risk of nodal metastasis remained even with small lesions less than or equal to 2 cm (6.3% risk). Patients with tumor size greater than 2 cm had a 26.3% incidence of nodal metastasis. In univariate analysis, the odds ratio (OR) for tumor size as a predictor of extrauterine disease was 1.4 (95% CI 1.2-1.6). In multivariate analysis, tumor size was not statistically significant. Only the lesions greater than or equal to 8 cm confer a risk that approaches previously identified well-known predictors. Tumor size was not found to be a statistically significant predictor of recurrence OR 1.3 (1.0-1.8).
  
  
  CONCLUSIONS
  Tumor size correlates with extrauterine disease, but it is not an independent prognostic variable. Although the risk of extrauterine disease increases with tumor size, the risk of nodal metastases remains even for those patients with very small tumors, underscoring the need for routine complete surgical staging. Tumor size does not appear to be an independent predictor of recurrence.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington Medical Center, Box 356460, Seattle, WA 98195-6460, USA. cshah@u.washington.edu
authors.forename: Chirag
authors.initials: C
authors.lastname: Shah
authors.forename: E Blair
authors.initials: EB
authors.lastname: Johnson
authors.forename: Elise
authors.initials: E
authors.lastname: Everett
authors.forename: Hisham
authors.initials: H
authors.lastname: Tamimi
authors.forename: Benjamin
authors.initials: B
authors.lastname: Greer
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Swisher
authors.forename: Barbara
authors.initials: B
authors.lastname: Goff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors