title: High-grade endometrial cancer: revisiting the impact of tumor size and location on outcomes.
abstract: OBJECTIVE
  Research on tumor size (TS) and intracavitary tumor location in endometrial cancer has focused primarily on low-grade tumors. Data in patients with high-grade histology are limited. Our goal is to determine if TS or lower uterine segment (LUS) involvement, is associated with nodal disease and recurrence in women with high-grade endometrial cancer.
  
  
  METHODS
  This is an IRB-approved, multi-institutional cohort study of patients with clinically early-stage, high-grade endometrial cancer who underwent comprehensive surgical staging. Records were reviewed for demographic, pathologic, and treatment data. Nodal involvement and recurrence as a function of TS and location were estimated with odds ratios and hazard ratios.
  
  
  RESULTS
  From 2005 to 2012, 208 patients were identified. Of these, 188 patients had tumor location and 183 had TS reported. There were 75 endometrioid (36.1%), 35 serous (16.8%), 12 clear cell (5.8%), and 26 carcinosarcoma (12.5%) cases, and 60 (28.8%) undifferentiated or mixed histologies. There were 55 recurrences (median follow up 17.2 mo). LUS tumors were associated with pelvic and para-aortic nodal disease (OR 3.83, 95% CI 1.70-8.60, p<0.01, OR 5.13, 95% CI 1.96-13.45, p<0.01). TS ≥ 2 cm was associated with pelvic nodal disease (27.4% vs. 0%, p=0.01; OR 10.00, p=0.01). Neither TS nor LUS location was independently associated with recurrence.
  
  
  CONCLUSIONS
  In high-grade endometrial cancers, tumor involvement of the LUS and TS>2 cm was associated with pelvic nodal disease, and LUS involvement was also significantly associated with para-aortic nodal disease. There was no association between LUS involvement or TS>2 cm and recurrence.
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA. Electronic address: kmdoll@med.unc.edu.
authors.forename: Kemi M
authors.initials: KM
authors.lastname: Doll
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Greater Baltimore Medical Center/John Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Tseng
authors.affiliation: Health Research Group, LLC, Asheville, NC, USA.
authors.forename: Sheri A
authors.initials: SA
authors.lastname: Denslow
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Greater Baltimore Medical Center/John Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Amanda Nickles
authors.initials: AN
authors.lastname: Fader
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
mesh_terms: D000368:Aged; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012189:Retrospective Studies
keywords: Endometrial cancer; Lower uterine segment; Nodal disease; Prognostic factors; Tumor size