title: Lower uterine segment involvement is associated with poor outcomes in early-stage endometrioid endometrial carcinoma.
abstract: BACKGROUND
  The clinicopathologic significance of lower uterine segment involvement (LUSI) in endometrial cancer patients remains unclear. Although LUSI has been reported to be a prognostic indicator, literature is limited.
  
  
  METHODS
  We studied 481 surgically staged endometrioid endometrial cancers with disease confined to the uterus (FIGO 1988 stage I or II). Primary outcomes were overall survival (OS) and disease-free survival (DFS). The relationships between LUSI and OS and DFS were assessed using the Kaplan-Meier method and Cox proportional hazard models. The t test or Fisher exact test was used for evaluating relationships between variables of interest.
  
  
  RESULTS
  LUSI was present in 223 cases (46.4%), and was associated with both decreased disease free survival (P = 0.02) and overall survival (P = 0.01) in univariate analysis. Multivariate analysis confirmed the association between LUSI and increased risk for recurrence [hazard ratio (HR) 2.27; 95% confidence interval (95% CI) 1.09-4.7; P = 0.03] and increased mortality (HR 1.76; 95% CI 1.12-2.78; P = 0.01).
  
  
  CONCLUSIONS
  LUSI in patients with early-stage endometrioid endometrial cancer is associated with decreased survival.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, MO, USA. kizern@wudosis.wustl.edu
authors.forename: Nora T
authors.initials: NT
authors.lastname: Kizer
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Saketh
authors.initials: S
authors.lastname: Guntupalli
authors.forename: Premal H
authors.initials: PH
authors.lastname: Thaker
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Powell
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Goodfellow
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.forename: Israel
authors.initials: I
authors.lastname: Zighelboim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000473:pathology* / Q000628:therapy; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014599:Uterus / Q000473:pathology*; D055815:Young Adult