title: Outcomes in surgical stage I uterine papillary serous carcinoma.
abstract: OBJECTIVE
  The optimal management of patients with stage I uterine papillary serous carcinoma (UPSC) is unclear. We sought to determine whether outcomes of women with surgical stage I UPSC differ with and without adjuvant therapy.
  
  
  METHODS
  Retrospective multi-institution analysis of women with stage I UPSC surgically staged from 1976 to 2006.
  
  
  METHODS
  comprehensive staging procedure including hysterectomy, bilateral salpingo-oophorectomy, selective pelvic/aortic lymphadenectomy, peritoneal cytology. Recurrence and survival were analyzed using Kaplan-Meier method.
  
  
  RESULTS
  Of 83 women with stage I UPSC, 36 (43%) received adjuvant therapies (23% radiotherapy, 3% chemotherapy, 15% chemotherapy and radiotherapy, 2% progestins). Three-year overall (OS) and progression-free survival (PFS) were 80% and 68%, respectively. Three-year OS and PFS by adjuvant treatment were observation (N=47) 86% and 78%, radiotherapy (N=17) 63% and 44%, chemotherapy with or without radiotherapy (N=17) 92% and 76%, respectively. Of the 18 recurrences, 9 (50%) included an extrapelvic component. Local recurrence was 2/30 (7%) following adjuvant radiotherapy and 7/53 (13%) without radiotherapy (p=0.48). Recurrence was higher in stage IB/IC (15/51, 29%) compared to stage IA (3/32, 9%). There has been one recurrence (5%) among the 22 women observed with stage IA disease.
  
  
  CONCLUSIONS
  In this largest reported series of women with surgical stage I UPSC, the high recurrence (29%) among patients with stage IB/IC disease highlights the need for clinical trials to test new therapeutic approaches. Surgically staged patients with IA disease had good prognosis. These data suggest that radiotherapy alone is not effective, that systemic therapy is needed, and that observation could be considered in patients with stage IA disease.
authors.affiliation: Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC 27710, USA. havri001@mc.duke.edu
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.forename: Victoria
authors.initials: V
authors.lastname: Bae-Jump
authors.forename: Tina
authors.initials: T
authors.lastname: Ayeni
authors.forename: Brian
authors.initials: B
authors.lastname: Calingaert
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Clarke-Pearson
authors.forename: Andrew
authors.initials: A
authors.lastname: Berchuck
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018284:Cystadenocarcinoma, Serous / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*