title: The importance of surgical staging in women with uterine serous carcinoma: experience in a single institution reveals a survival benefit.
abstract: OBJECTIVE
  To assess the appropriate extent of surgical staging in women with clinically early stage uterine serous carcinoma (USC).
  
  
  METHODS
  We conducted a single-institution retrospective cohort study of all women with USC between 2007 and 2012. Treatment practices, outcomes, and factors affecting survival were analyzed using univariate and multivariate analysis.
  
  
  RESULTS
  Eighty-four patients were identified, 76 of whom were included in the analysis. Preoperative pathology correctly identified USC in 73.3% of cases. Surgical stage distribution was 44.7% stage I, 7.9% stage II, 31.6% stage III, and 15.8% stage IV. Women thought to have early stage disease preoperatively encompassed 84.2% (64) of the cohort. Fifty-two (81.3%) of these women with clinically early stage disease had complete surgical staging. Thirty-four (53.1%) were determined to have surgical stage I, and the remaining 30 (46.9%) had occult advanced stage disease. Median follow-up was 43.2 months. Univariate analysis found a significant increase in progression-free survival and overall survival for women with clinically early stage disease with positive lymphovascular space invasion (P < 0.001 and P = 0.002, respectively), positive peritoneal cytology (P = 0.022 and P = 0.04, respectively), early stage (P < 0.001 and P = 0.004, respectively), and elevated serum CA125 at diagnosis (P = 0.003 and P = 0.001, respectively). On multivariate analysis, early stage (hazard ratio [HR] 9.87; 95% CI 2.79 to 34.92, P < 0.001) and complete surgical staging (HR 2.96; 95% CI 1.05 to 8.37, P = 0.040) were associated with prolonged progression-free survival, while overall survival was not affected by complete surgical staging (HR 1.92; 95% CI 0.64 to 5.76, P = 0.79).
  
  
  CONCLUSIONS
  Complete surgical staging prolongs the progression-free survival of women with clinical early-stage uterine serous cancer. Although this does not extend to overall survival, this enables patients to have an improved quality of life with a longer interval without the burden of disease.
authors: Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary AB.
authors: Allison
authors: A
authors: Ball
authors: Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary AB.
authors: Pamela
authors: P
authors: Chu
authors: Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary AB.
authors: Prafull
authors: P
authors: Ghatage
authors: Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary AB.
authors: Jill
authors: J
authors: Nation
authors: Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary AB.
authors: Gregg
authors: G
authors: Nelson
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D002277:Carcinoma / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016019:Survival Analysis; D014594:Uterine Neoplasms / Q000401:mortality / Q000473:pathology*; D014599:Uterus / Q000473:pathology*
keywords: chemotherapy; surgical staging; survival analysis; uterine cancer treatment; uterine serous carcinoma