An analysis of current treatment practice in uterine papillary serous and clear cell carcinoma at two high volume cancer centers.
OBJECTIVE
Despite the rarity of uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCCC), they contribute disproportionately to endometrial cancer deaths. Sufficient clinical information regarding treatment and prognosis is lacking. The aim of this study is to evaluate treatment outcomes in a rare cancer cohort based on the experience at two tertiary care cancer centers.


METHODS
Clinicopathologic data were retrospectively collected on 279 patients with UPSC and UCCC treated between 1995 to 2011. Mode of surgery, use of adjuvant treatment, and dissection of paraaoritc lymph nodes were evaluated for their association with overall survival (OS) and progression-free survival (PFS).


RESULTS
40.9% of patients presented with stage I disease, 6.8% of patients presented with stage II disease and 52.3% of patients presented with stages III and IV. Median follow-up was 31 months (range, 1 to 194 months). OS and PFS at 5 years were 63.0% and 51.9%, respectively. OS and PFS were not affected by mode of surgery (open vs. robotic approach; OS: hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.28 to 1.62; PFS: HR, 0.78; 95% CI, 0.40 to 1.56). Adjuvant treatment was associated with improved OS in stages IB-II (HR, 0.14; 95% CI, 0.02 to 0.78; p=0.026) but not in stage IA disease. There was no difference in OS or PFS based on the performance of a paraaoritc lymph node dissection.


CONCLUSIONS
Minimally invasive surgical staging appears a reasonable strategy for patients with non-bulky UPSC and UCCC and was not associated with diminished survival. Adjuvant treatment improved 5-year survival in stages IB-II disease.
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA. Tilley.JenkinsVogel@cshs.org.
Tilley Jenkins
TJ
Vogel
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA.
Abhay
A
Knickerbocker
Division of Oncology and Pelvic Surgery, Pacific Gynecology Specialists, Seattle, WA, USA.
Chirag A
CA
Shah
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA.; Department of Epidemiology, University of Washington School of Medicine, Seattle, WA, USA.
Melissa A
MA
Schiff
CellNetix Pathology and Laboratories, Seattle, WA, USA.
Christina
C
Isacson
Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA.
Rochelle L
RL
Garcia
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA.
Barbara A
BA
Goff
D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D000368:Aged; D017024:Chemotherapy, Adjuvant; D018283:Cystadenocarcinoma, Papillary / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011364:Professional Practice; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016019:Survival Analysis; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology / Q000628:therapy*
Adenocarcinoma, Clear Cell; Disease-free Survival; Endometrial Neoplasms; Lymph Node Excision; Retrospective Studies