title: The prognostic significance of positive peritoneal cytology and adnexal/serosal metastasis in stage IIIA endometrial cancer.
abstract: OBJECTIVE
  The clinical significance and optimal management of patients with stage IIIA endometrial cancer are controversial. We sought to determine whether recurrence and survival of patients with stage IIIA endometrial cancer differ with surgical pathologic findings (positive peritoneal cytology versus positive adnexae or serosa) and adjuvant treatment.
  
  
  METHODS
  Retrospective single institution analysis of patients surgically staged for IIIA endometrial cancer at Duke University Medical Center from 1973 to 2002. Stage IIIA patients were stratified into positive cytology alone (group IIIA1, n=37) and positive adnexae or uterine serosa (group IIIA2, n=20). Comparison was made with previously reported group of 467 patients with surgical stage I/II disease. Recurrence and survival were analyzed using Kaplan-Meier estimations and Cox proportional hazards model.
  
  
  RESULTS
  Mean age of 57 patients with stage IIIA endometrial cancer was 63. Adjuvant therapies were administered to 89% patients (74% radiotherapy, 4% chemotherapy, 19% progestins). Five-year overall (OS) and recurrence-free disease-specific survival (RFDSS) were 64% and 76%, respectively. Survival was similar comparing IIIA1 (62%) and IIIA2 (68%, p=0.999). RFDSS by adjuvant therapy was: external beam radiotherapy 89% (n=10), intraperitoneal P32 84% (n=21), progestins 78% (n=9), none 75% (n=6). 61% recurrences included extrapelvic component. In multivariable analysis of stage I-IIIA patients (n=517), positive cytology but not adnexal/serosal metastasis was predictive of death (HR 1.70, 95% CI 1.06-2.73) and disease recurrence (HR 1.70, 95% CI 1.07-2.71).
  
  
  CONCLUSIONS
  Among patients with stage IIIA endometrial cancer, metastasis to adnexae or serosa does not appear to confer worse prognosis than positive cytology alone. Positive cytology is an independent predictor of prognosis among patients with stage I-IIIA endometrial cancer. While optimal adjuvant therapy for these groups remains unclear, recurrence patterns suggest that systemic therapies are appropriate.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Box 3079, Durham, NC 27710, USA. havri001@mc.duke.edu
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Janiel M
authors.initials: JM
authors.lastname: Cragun
authors.forename: Brian
authors.initials: B
authors.lastname: Calingaert
authors.forename: Angeles
authors.initials: A
authors.lastname: Alvarez Secord
authors.forename: Fidel A
authors.initials: FA
authors.lastname: Valea
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Clarke-Pearson
authors.forename: Andrew
authors.initials: A
authors.lastname: Berchuck
authors.forename: John T
authors.initials: JT
authors.lastname: Soper
mesh_terms: D000290:Adnexa Uteri / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000628:therapy; D005185:Fallopian Tube Neoplasms / Q000556:secondary*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000556:secondary*; D010529:Peritoneal Cavity / Q000473:pathology*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies