Analysis of initial failure site and spread pattern in endometrial carcinoma: a Japanese experience

Kasamatsu T, Shiromizu K, Takahashi M, Matsumoto K, Shirai T. Analysis of initial failure site and spread pattern in endometrial carcinoma: a Japanese experience. This retrospective study was undertaken in an attempt to identify initial failure sites and spread patterns in patients with endometrial carcinoma in Japan. A retrospective clinicopathologic review of 272 patients treated from 1983 to 1994 at Saitama Cancer Center was performed. Patients underwent total hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Postoperative external radiation was given to the patients with deep myometrial invasion, high grade tumor, and/or lymph node metastasis. Following surgery, chemotherapy was given to the patients with extrapelvic metastasis. Of the 272 patients, 262 had no residual disease after initial treatment and 10 had confirmed residual disease. Of the 262 patients, 32 (12.2%) suffered recurrence. The recurrence rates for stage I, II, III, and IV were 5.6% (10/178), 5.7% (2/35), 35.3% (18/51), and 100% (2/2), respectively. Of the 32 patients who failed, 6 (18.8%) experienced local failure, 13 (40.6%) had distant failure without peritoneal spread, and 13 (40.6%) had distant failure with peritoneal spread. In distant failure, the incidence of peritoneal spread was highest (50.0%, 13/26), closely followed by that of pulmonary metastasis (46.2%, 12/26). Furthermore, of those patients with residual disease, peritoneal spread was found in 80% (8 of 10). Five of the six patients (83.3%) with local failure survive, but all patients with peritoneal spread have died. Peritoneal dissemination is an important failure pattern and should be considered a top priority in an attempt to improve survival in patients with endometrial carcinoma.