title: An updated clinicopathologic study of early-stage uterine papillary serous carcinoma (UPSC).
abstract: OBJECTIVE
  Stage I-II uterine papillary serous carcinoma (UPSC) patients have a significant risk for extrapelvic recurrence. However, clinicopathologic risk factors for recurrence are not well understood. This study was undertaken to define the prognostic factors for recurrence and survival in patients with early-stage UPSC.
  
  
  METHODS
  A retrospective, multi-institution analysis of surgically staged I-II UPSC patients was performed. Patients were treated by various adjuvant modalities. Age, race, sub-stage, percentage UPSC histology, lymphvascular space invasion (LVSI), tumor size and adjuvant treatment modality were evaluated for their effect on recurrence and survival outcomes.
  
  
  RESULTS
  We identified 206 patients. Forty patients (19.4%) had 5-49% UPSC, 55 (26.7%) had 50-99% and 111 patients (53.9%) had 100% UPSC in their respective uterine specimens. Twenty one percent of patients experienced a primary recurrence. On univariate analysis, age, increasing %UPSC, LVSI, and tumor size were not significantly associated with recurrence or progression-free survival (PFS). However, substage (p=0.005) and treatment with platinum/taxane-based chemotherapy (p=0.001) were associated with recurrence/PFS. On multivariate analysis, only chemotherapy (p=0.01) was a significant factor affecting PFS, whereas age (p=0.05), substage (p=0.05), and chemotherapy (p=0.02) were associated with overall survival.
  
  
  CONCLUSIONS
  Traditional risk factors for recurrence and survival in patients with early-stage endometrial cancer may not be relevant in patients with UPSC. Patients with any percentage UPSC in their uterine specimens are at a significant risk for recurrence and poor survival outcomes. Given that current clinicopathologic data does not accurately identify women most likely to benefit from adjuvant therapy, alternative prognostic markers based on novel techniques should be explored.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Cleveland Clinic, Cleveland, OH, USA. amanditan@yahoo.com
authors.forename: Amanda Nickles
authors.initials: AN
authors.lastname: Fader
authors.forename: David
authors.initials: D
authors.lastname: Starks
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Frasure
authors.forename: David M
authors.initials: DM
authors.lastname: O'Malley
authors.forename: Erin R
authors.initials: ER
authors.lastname: Tuller
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Moore
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
authors.forename: Allison E
authors.initials: AE
authors.lastname: Axtell
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kelley
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Zanotti
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D002291:Carcinoma, Papillary / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery
chemical_list: D001952:Bridged-Ring Compounds; D009944:Organoplatinum Compounds; D043823:Taxoids; C080625:taxane