title: Lower uterine segment involvement is associated with adverse outcome in patients with stage I endometroid endometrial cancer: results of a multicenter study.
abstract: OBJECTIVE
  To quantify the relative risk associated with lower uterine segment involvement (LUSI) on outcome measures in patients with apparent stage I endometroid endometrial cancer.
  
  
  METHODS
  A cohort of 769 consecutive patients with endometroid endometrial carcinoma apparent stage I, who underwent surgery in five gynecological oncology centers in Israel; 138 patients with and 631 without LUSI were followed for a median time of 51 months. Local recurrence, recurrence-free and overall survival were compared between the two groups.
  
  
  RESULTS
  LUSI was associated with grade 3 tumor (p=0.002), deep myometrial invasion (p<0.001), and the presence of lymphvascular space involvement (p=0.01). There were 22 cases of local recurrences, 40 cases of distal recurrences and 80 patients died. Univariate survival analysis showed that patients with LUSI had trend toward lower regional recurrence-free survival (p=0.09), and significant lower distant recurrence-free survival (p=0.04) and lower overall survival (p=0.002). The Cox proportional hazards model demonstrated a significantly decreased overall survival (HR=2.3; 95% CI 1.3, 3.9; p=0.003) in cases with LUSI.
  
  
  CONCLUSIONS
  In patients with apparent stage I endometroid endometrial cancer, the presence of LUSI is a poor prognostic factor, associated with a significantly higher risk of distal recurrence and death. The presence of LUSI warrants consideration when deciding upon surgical staging or postoperative management.
authors.affiliation: Department of Obstetrics and Gynecology, Barzilai Medical Center, Ashkelon, Israel. gemer@barzi.health.gov.il
authors.forename: O
authors.initials: O
authors.lastname: Gemer
authors.forename: M
authors.initials: M
authors.lastname: Gdalevich
authors.forename: M
authors.initials: M
authors.lastname: Voldarsky
authors.forename: F
authors.initials: F
authors.lastname: Barak
authors.forename: A
authors.initials: A
authors.lastname: Ben Arie
authors.forename: D
authors.initials: D
authors.lastname: Schneider
authors.forename: T
authors.initials: T
authors.lastname: Levy
authors.forename: E Y
authors.initials: EY
authors.lastname: Anteby
authors.forename: O
authors.initials: O
authors.lastname: Lavie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome; D014599:Uterus / Q000473:pathology*