title: Impact of tubal ligation on routes of dissemination and overall survival in uterine serous carcinoma.
abstract: OBJECTIVE
  Abdominal peritoneal implants are characteristic of uterine serous carcinoma (USC). The presumed mechanism of dissemination is retrograde transit via the fallopian tube. We assessed the impact of tubal ligation (TL) on the metastatic profile and survival of USC patients.
  
  
  METHODS
  Patient risk factors, process-of-care variables, and disease-specific parameters were annotated. Categorical variables were compared using the χ(2) test. Overall survival (OS) was estimated via the Kaplan-Meier method.
  
  
  RESULTS
  Among 211 USC patients, fallopian tube status was documented in 142 patients; 35 had a history of TL and 107 did not. When comparing patients with and without TL, positive peritoneal cytology was present, respectively, in 18.8% vs 45.0% (P=.01) and stage IV disease in 14.3% vs 34.6% (P=.02). Using Cox models, age was the sole significant determinant of OS in stage I/II USC. By contrast, age, lymphovascular space involvement, positive cytology, and TL independently and adversely affected survival in stage III/IV USC. Adjusting for these factors in a multivariable model, the association between TL and OS among patients with advanced disease yielded a hazard ratio of 8.61 (95% CI, 3.08-24.03; P<.001). The prevalence of lymphatic metastasis and nodal tumor burden was significantly greater in patients who underwent ligation.
  
  
  CONCLUSIONS
  Patients with TL had significantly lower rates of positive cytology and stage IV disease than patients without TL. The lymphatic system appeared to be the dominant mode of spread after TL and was associated with a paradoxic worsening of OS, perhaps reflecting a delay in diagnosis.
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Tina A
authors.initials: TA
authors.lastname: Ayeni
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jamie N
authors.initials: JN
authors.lastname: Bakkum-Gamez
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Michaela E
authors.initials: ME
authors.lastname: McGree
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Mariam M
authors.initials: MM
authors.lastname: AlHilli
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Janice R
authors.initials: JR
authors.lastname: Martin
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Keeney
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: podratz.karl@mayo.edu.
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
mesh_terms: D000368:Aged; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013246:Sterilization, Tubal; D014594:Uterine Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery