Clinicopathological prognostic factors and the role of cytoreduction in surgical stage IVb endometrial cancer: a retrospective multi-institutional analysis of 248 patients in Japan.
OBJECTIVE
To evaluate clinicopathological prognostic factors and the impact of cytoreduction in patients with surgical stage IVb endometrial cancer (EMCA).


METHODS
The records of 248 patients with stage IVb EMCA who underwent primary surgery including hysterectomy at multiple institutions from 1996 to 2005 were retrospectively analyzed. Data regarding disease distribution, surgical procedures, adjuvant therapy, and survival times were collected. Univariate and multivariate analyses were performed to identify factors associated with overall survival (OS).


RESULTS
The median OS was 24 months. The most common histological types were endometrioid (grade 1: 15%, grade 2: 20%, grade 3: 24%) and serous (17%). The most common sites of intra-abdominal metastases were pelvis (65%), ovaries (58%), omentum (58%), retroperitoneal lymph nodes (52%), and upper abdominal peritoneum (44%). In 93 patients with extra-abdominal metastases, the most common site was the lung (n=49). Complete resection of extra-abdominal metastases was achieved in only 13 patients. Complete resection of intra-abdominal metastases was achieved in 101 patients, 52 had ≤1 cm residual disease, and 95 had >1cm residual disease; the median OS times in these groups were 48, 23, and 14 months, respectively (p<0.0001). Multivariate analysis showed that performance status, histology/grade, adjuvant treatment, and intra-abdominal residual disease were independent prognostic factors. Intra-abdominal residual disease was an independent prognostic factor in patients with and without extra-abdominal metastases.


CONCLUSIONS
Cytoreductive surgery and adjuvant therapy may improve survival in stage IVb EMCA, particularly in patients with favorable prognostic factors, even in the presence of extra-abdominal metastases.
Gynecology Service, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan. teto@nk-cc.go.jp
Takako
T
Eto
Toshiaki
T
Saito
Takahiro
T
Kasamatsu
Toru
T
Nakanishi
Harushige
H
Yokota
Toyomi
T
Satoh
Takayoshi
T
Nogawa
Hiroyuki
H
Yoshikawa
Toshiharu
T
Kamura
Ikuo
I
Konishi
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002296:Carcinosarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007564:Japan; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis