title: Correlation of tumor size with other prognostic factors in uterine serous carcinoma: a large multi-institutional study.
abstract: OBJECTIVE
  Uterine serous carcinoma (USC) constitutes 10% of uterine cancers but ~40% of deaths. Tumor size is a known prognostic factor in other solid tumors. In endometriod cancers it is one element used to identify the need for complete staging, while its significance in USC is debated. Therefore tumor size was examined as an independent prognostic factor.
  
  
  METHODS
  Clinical and pathologic variables were recorded for 236 institutional patients, and those patients in the SEER database with USC. Chi-square and Fisher exact t-tests were utilized and survival data generated via Kaplan-Meier method; multivariate analysis was performed via cox-regression.
  
  
  RESULTS
  The patients' mean age was 67.2 years (range 40-91). Survival ranged from 0 to 184 months (mean 42.8). We used a tumor size cut-off of 1cm and noted significant associations with myometrial invasion (p<0.0001), angiolymphatic invasion (p<0.0001), peritoneal washings (p=0.03), stage (p=0.015) and positive lymph nodes (p=0.05). Furthermore, recurrence was associated with larger tumors (p=0.03). In multivariate analysis, extra-uterine disease was the only factor associated with both recurrence and survival. Review of the SEER database noted association of larger tumors with lymph node involvement and a significant survival advantage with tumors <1cm in both univariate and multivariate analysis.
  
  
  CONCLUSIONS
  Treatment options for USC are often predicated on the surgical stage and therefore components of the staging are vitally important. The 1cm tumor-size cut-off should be studied prospectively as a prognostic indicator of survival and recurrence in USC and considered for inclusion in USC staging.
authors.affiliation: Division of Gynecologic Oncology, Department of OB/GYN, Wayne State University and Karmanos Cancer Institute, Detroit, MI, USA.
authors.forename: I
authors.initials: I
authors.lastname: Winer
authors.forename: H
authors.initials: H
authors.lastname: Mahdi
authors.forename: S
authors.initials: S
authors.lastname: Bandyopadhyay
authors.forename: A
authors.initials: A
authors.lastname: Semaan
authors.forename: K K
authors.initials: KK
authors.lastname: Van de Vijver
authors.forename: M R
authors.initials: MR
authors.lastname: Nucci
authors.forename: F
authors.initials: F
authors.lastname: Abdul-Karim
authors.forename: Y
authors.initials: Y
authors.lastname: Hussein
authors.forename: F
authors.initials: F
authors.lastname: Qureshi
authors.forename: K
authors.initials: K
authors.lastname: Hayek
authors.forename: B
authors.initials: B
authors.lastname: Alosh
authors.forename: D
authors.initials: D
authors.lastname: Schulz
authors.forename: M
authors.initials: M
authors.lastname: Cote
authors.forename: A
authors.initials: A
authors.lastname: Munkarah
authors.forename: R
authors.initials: R
authors.lastname: Morris
authors.forename: E
authors.initials: E
authors.lastname: Oliva
authors.forename: R
authors.initials: R
authors.lastname: Ali-Fehmi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018284:Cystadenocarcinoma, Serous / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery