Regular articleUterine papillary serous carcinoma: comparisons of outcomes in surgical Stage I patients with and without adjuvant therapy
Introduction
Uterine papillary serous carcinoma (UPSC) was originally described as a distinct type of endometrial carcinoma by Lauchlan et al. and Hendrickson et al. approximately 20 years ago and currently represents 4% of all endometrial carcinomas [1], [2]. UPSC histologically resemble serous adenocarcinomas of the ovary [1], [2], [3] and indeed, studies relying on comprehensive surgical staging similar to that observed with ovarian carcinoma demonstrate that the majority of UPSC cases are associated with extrauterine disease [4], [5], [6]. Moreover, UPSC has a higher risk of recurrence and is typically associated with a worse prognosis than endometrioid adenocarcinomas of the endometrium [1], [2], [3], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]. Various studies have demonstrated survival rates of 15–51% in clinical Stage I disease and 35–50% for surgical Stage I/II disease [1], [2], [10], [12], [13], [17], [19], [20]. Aside from the very limited number of studies that incorporate comprehensive surgical staging, the majority of these reports used clinical parameters for staging or very limited surgical staging techniques and information.
The appropriate postoperative management of UPSC patients is unknown. Commonly suggested adjuvant therapies include whole pelvic radiation therapy, whole abdominal radiation therapy, or cytotoxic chemotherapy. These adjuvant treatment recommendations are largely based on very small patient series (<20 patients), only a fraction of which include surgically staged patients [1], [2], [10], [12], [13], [17], [19], [20].
The purpose of this study was to evaluate survival outcomes in a cohort of patients with Stage I UPSC following comprehensive surgical staging who were treated with and without adjuvant therapy.
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Materials and methods
Following approval from the Institutional Review Board, patients with FIGO Stage I uterine papillary serous carcinoma diagnosed from 1987 to 2000 were identified from tumor registry databases at the following institutions: The University of Alabama at Birmingham, Washington University School of Medicine, Ohio State University School of Medicine, and The University of Oklahoma Health Science Center. A retrospective chart review identified patients who underwent comprehensive surgical staging for
Patient characteristics
Sixty patients with FIGO surgical Stage I UPSC were identified. All patients underwent surgical staging as previously outlined. The median age of the population was 68.5 years (mean, 69 years; range, 45–84 years); 15% of cases were admixed with either adenocarcinoma of the endometrium or clear cell carcinoma. Nineteen patients had Stage IA disease, 27 patients had Stage IB disease, and 14 patients were diagnosed with Stage IC disease. The number of lymph nodes evaluated was provided in 90% of
Discussion
UPSC has been identified as a distinct variant of endometrial cancer and it has been reported to be associated with more aggressive behavior and a worse prognosis than endometrioid adenocarcinomas of the endometrium [1], [2], [3]. A significant amount of controversy surrounds the optimal management of patients with Stage I UPSC, and appropriate management of these patients has yet to be firmly established. The low incidence of this particular type of cancer, the variety of surgical
Acknowledgements
This paper was presented at the 34th Annual Meeting of the Society of Gynecologic Oncologists in New Orleans, Louisiana, February 4, 2003.
References (33)
- et al.
Adenocarcinoma of the endometriumanalysis of 256 cases with carcinoma limited to the uterine corpus. Pathology review and analysis of prognostic variables
Gynecol Oncol
(1982) - et al.
Virulence of papillary endometrial carcinoma
Gynecol Oncol
(1990) - et al.
Uterine papillary serous carcinomapatterns of metastatic spread
Gynecol Oncol
(1994) - et al.
What staging surgery should be performed on patients with uterine papillary serous carcinoma
Gynecol Oncol
(1999) - et al.
Serous papillary serous carcinoma of the endometriuma histopathologic study of 22 cases
Gynecol Oncol
(1990) - et al.
Papillary carcinomas of the endometrium
Gynecol Oncol
(1990) - et al.
Papillary serous and clear cell type lead to poor prognosis of endometrial carcinoma in black women
Gynecol Oncol
(1997) - et al.
Malignant papillary lesions of the endometrium
Gynecol Oncol
(1987) - et al.
Uterine papillary serous carcinomaa study on 108 cases with emphasis on the prognostic significance of associated endometroid carcinoma, absence of invasion, and concomitant ovarian carcinoma
Gynecol Oncol
(1992) - et al.
Papillary serous adenocarcinoma of the endometriuma clinicopathologic study of 19 cases
Gynecol Oncol
(1992)
The outcome of stage I–II clinically and surgically staged papillary serous and clear cell endometrioid cancers when compared with endometrioid carcinoma
Gynecol Oncol
Extended surgical staging for uterine papillary serous carcinomasurvival outcome of locoregional (Stage I–III) disease
Gynecol Oncol
Uterine papillary serous carcinoma (UPSC)a clinicopathologic study of 30 cases
Gynecol Oncol
Uterine papillary serous carcinomaevaluation of long-term survival in surgically staged patients
Gynecol Oncol
Influence of postoperative treatment on survival in patients with uterine papillary serous carcinoma
Gynecol Oncol
Management of aggressive histologic variants of endometrial carcinoma at the Tom Baker Cancer Centre between 1984 and 1994
Gynecol Oncol
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