title: Stage I noninvasive and minimally invasive uterine serous carcinoma: comprehensive staging associated with improved survival.
abstract: OBJECTIVE
  The aim of this study was to determine if comprehensive surgical staging is a better predictor of outcome than incomplete staging for women with stage I noninvasive or minimally invasive (≤3 mm) uterine serous carcinoma (USC).
  
  
  METHODS
  Retrospective chart review was used to identify patients undergoing hysterectomy at the Johns Hopkins Hospital from 1989 to 2010. Relevant clinical and pathologic data were extracted. Patients with noninvasive and minimally invasive (≤3-mm myometrial invasion) USC were identified. Stage was assigned based on the 2009 International Federation of Gynecology and Obstetrics endometrial cancer criteria. Survival curves were generated using the Kaplan-Meier method.
  
  
  RESULTS
  We identified 63 patients with noninvasive or minimally invasive (≤3 mm) USC. Stages I, II, III, and IV disease were noted in 65% (41/63), 6% (4/63), 14% (9/63), and 14% (9/63) of the patients, respectively. Lower stage was associated with a significantly improved disease-specific survival (P = 0.001). Comprehensive staging, including total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy, and peritoneal biopsies, was completed in 29% (12/41) of the patients with stage I disease. There were no disease-specific deaths in the comprehensive staging group. Compared with incomplete staging, comprehensive staging was associated with a significantly improved disease-specific survival (P = 0.039).
  
  
  CONCLUSIONS
  Patients with stage I noninvasive and minimally invasive USC on comprehensive staging have an excellent prognosis. Adjuvant therapy may not benefit this patient population.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. rgiunto1@jhmi.edu
authors.forename: Robert L
authors.initials: RL
authors.lastname: Giuntoli
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Gerardi
authors.forename: Anna V
authors.initials: AV
authors.lastname: Yemelyanova
authors.forename: Stefanie M
authors.initials: SM
authors.lastname: Ueda
authors.forename: Aimee C
authors.initials: AC
authors.lastname: Fleury
authors.forename: Teresa P
authors.initials: TP
authors.lastname: Diaz-Montes
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D018284:Cystadenocarcinoma, Serous / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D014594:Uterine Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery