Endometrial carcinoma with extra-abdominal metastasis: improved prognosis following cytoreductive surgery.
BACKGROUND
Incidence of endometrial carcinoma, the most common malignancy of the female pelvis, has been steadily increasing during the last three decades. The prognosis for stage IVb cases with extra-abdominal metastases is extremely poor, with no current consensus regarding treatment. The aim of the present study was to examine the benefits of cytoreductive surgery for such cases.


METHODS
Clinicopathological features of 33 stage IVb cases of endometrial carcinoma diagnosed during the 1991-2008 study period were retrospectively reviewed utilizing clinical records. Cytoreduction was conducted in 30 cases.


RESULTS
The median progression-free survival (PFS) and overall survival (OS) of those patients with optimal cytoreduction of their disease (with residual masses < or =2 cm), were significantly better than those with suboptimal reduction (with residual masses > 2 cm), not only among the 15 stage IVb patients with only intra-abdominal metastasis (group I) (P = 0.0003 and 0.0007) but also among the 15 cases with extra-abdominal metastasis (group E) (P = 0.013 and 0.016). Multivariate Cox proportional-hazards analysis demonstrated that the adjusted hazard ratio (HR) for the maximum size of residual disease (>2 vs. < or =2 cm) was 10.4 [95% confidence interval (CI), 1.27-84.70, P = 0.030] in group I and 16.92 (95% CI, 1.41-203.09, P = 0.026) in group E.


CONCLUSIONS
This is the first demonstration that aggressive cytoreductive surgery for stage IVb endometrial carcinoma with extra-abdominal metastasis has a beneficial role. However, further investigation is still required to establish better standard therapy for stage IVb endometrial cancer.
Ueda
Yutaka
Y
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan. ZVF03563@nifty.ne.jp
Enomoto
Takayuki
T
Miyatake
Takashi
T
Egawa-Takata
Tomomi
T
Ugaki
Hiromi
H
Yoshino
Kiyoshi
K
Fujita
Masami
M
Kimura
Tadashi
T
D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000368:Aged; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome