title: Impact of adjuvant chemotherapy and pelvic radiation on pattern of recurrence and outcome in stage I non-invasive uterine papillary serous carcinoma. A multi-institution study.
abstract: OBJECTIVE
  To determine the impact of adjuvant chemotherapy or pelvic radiation on risk of recurrence and outcome in stage IA non-invasive uterine papillary serous carcinoma (UPSC).
  
  
  METHODS
  This is a multi-institutional retrospective study for 115 patients with stage IA non-invasive UPSC (confined to endometrium) treated between 2000 and 2012. Kaplan-Meier and multivariable Cox proportional hazards regression modeling were used.
  
  
  RESULTS
  Staging lymphadenectomy and omentectomy were performed in 84% and 57% respectively. Recurrence was seen in 26% (30/115). Sites of recurrences were vaginal in 7.8% (9/115), pelvic in 3.5% (4/115) and extra-pelvic in 14.7% (17/115). Adjuvant chemotherapy did not impact risk of recurrence (25.5% vs. 26.9%, p=0.85) even in subset of patients who underwent lymphadenectomy (20% vs. 23.5%, p=0.80). These findings were consistent for pattern of recurrence. Among those who underwent lymphadenectomy, adjuvant chemotherapy did not impact progression-free survival (p=0.34) and overall survival (p=0.12). However among patients who did not have lymphadenectomy, adjuvant chemotherapy or pelvic radiation was associated with longer progression-free survival (p=0.04) and overall survival (p=0.025). In multivariable analysis, only staging lymphadenectomy was associated with improved progression-free survival (HR 0.34, 95% CI 0.12-0.95, p=0.04) and overall survival (HR 0.35, 95% CI 0.12-1.0, p=0.05). Neither adjuvant chemotherapy nor pelvic radiation were predictors of progression-free or overall survivals.
  
  
  CONCLUSIONS
  In stage IA non-invasive UPSC, staging lymphadenectomy was significantly associated with recurrence and outcome and therefore, should be performed in all patients. Adjuvant chemotherapy or pelvic radiation had no impact on outcome in surgically staged patients but was associated with improved outcome in unstaged patients.
authors: Gynecologic Oncology division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: mahdih6281@gmail.com.
authors: Haider
authors: H
authors: Mahdi
authors: Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA.
authors: Mohamed A
authors: MA
authors: Elshaikh
authors: Gynecologic Oncology division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
authors: Robert
authors: R
authors: DeBenardo
authors: Division of Gynecologic Oncology, Department of Women's Health, Obsterics & Gynecology, Henry Ford Health System, Detroit, MI, USA.
authors: Adnan
authors: A
authors: Munkarah
authors: Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA.
authors: Derek
authors: D
authors: Isrow
authors: Division of Gynecologic Oncology, University Hospitals, Cleveland, OH, USA.
authors: Sareena
authors: S
authors: Singh
authors: Division of Gynecologic Oncology, University Hospitals, Cleveland, OH, USA.
authors: Steven
authors: S
authors: Waggoner
authors: Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
authors: Rouba
authors: R
authors: Ali-Fehmi
authors: Division of Gynecologic Oncology, Wayne State University School of Medicine, Detroit, MI, USA.
authors: Robort T
authors: RT
authors: Morris
authors: Department of Epidemiology, Case Western University, Cleveland, OH, USA.
authors: Jarod
authors: J
authors: Harding
authors: Gynecologic Oncology division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
authors: Mehdi
authors: M
authors: Moslemi-Kebria
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D018283:Cystadenocarcinoma, Papillary / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010388:Pelvis / Q000528:radiation effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
keywords: Adjuvant therapy; Chemotherapy; Non-invasive uterine papillary serous carcinoma; Radiotherapy; Recurrence; Stage IA; Surgical staging; outcome