Transection of vaginal cuff is an independent prognostic factor in stage I endometrial cancer.
OBJECTIVE
The objective was to identify prognostic factors of disease-free and overall survival in stage I endometrial carcinoma, thereby potentially facilitating the selection of patients who are on high risk for recurrence and who may benefit from transection of a vaginal cuff.


METHODS
In a retrospective review between 1994 and 2004, 340 patients with stage I endometrial carcinoma were managed surgically at two different hospitals in Rostock. The median follow-up was 79 (range 12-161) months. Clinical and histological parameters were compared using the SPSS software package.


RESULTS
In the univariate analysis the factors associated with poor disease-free survival in stage I carcinoma were higher tumor grade (P=0.013), and no removed vaginal cuff (P=0.025). The corresponding factor for impaired overall survival was no removed vaginal cuff (P=0.003). All parameters with a P-value<0.25 in the univariate setting were entered into a multivariate analysis. The factors that maintained associated with poor disease-free and overall survival were higher tumor grade and lack of vaginal cuff.


CONCLUSIONS
The removal of a vaginal cuff during abdominal hysterectomy was found to be an independent prognostic factor in stage I endometrial carcinomas. A prospective surgical trial is needed to validate our results before changing current clinical practice.
Arndt-Miercke
H
H
Department of Obstetrics and Gynecology, University of Rostock, Klinikum Suedstadt, Suedring 81, 18059 Rostock, Germany.
Martin
A
A
Briese
V
V
Fietkau
R
R
Gerber
B
B
Reimer
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011859:Radiography; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014621:Vagina / Q000473:pathology / Q000601:surgery*