Multicenter analysis of recurrence and survival in stage IIIA endometrial cancer

To determine factors related to recurrence and survival in women with stage IIIA endometrial cancer; to examine outcomes of women with IIIA1 disease.

Multi-institutional analysis of women with stage IIIA endometrial carcinoma undergoing hysterectomy, bilateral salpingo-oophorectomy, lymphadenectomy, and pelvic cytology between 1980 and 2008. Overall survival (OS) and recurrence-free disease specific survival (RFDSS) were compared using Kaplan-Meier method, univariate and multivariate analyses.

98 women underwent surgical staging for stage IIIA endometrial carcinoma. Pelvic washings were positive in 53%, serosa in 18%, and adnexae in 45%. Forty were IIIA1; 58 were IIIA2 (adnexal/serosal involvement). Median number of lymph nodes was 19 (range 1-73). Adjuvant treatment was given to 88%: radiotherapy--21%, chemotherapy - 19%, chemotherapy and radiotherapy--19%, hormonal therapy--16%, and intraperitoneal P-32 - 11%. Five-year OS and RFDSS for IIIA1 were 77% and 76%, respectively; and for IIIA2 were 75% and 73%, respectively (p=NS for both). Patients with IIIA1 disease were less likely to receive chemotherapy or radiotherapy than those with IIIA2 disease (p=0.0035). Older age (Hazard ratio 1.24; 95% CI 1.00-1.54), non-Caucasian race (HR 5.35; 95% CI 1.96-14.5), and cervical metastases (HR 3.3; 95% CI 1.3-8.7) predicted lower RFDSS in multivariate analysis. Among 24 patients meeting NCCN's observation criteria (IIIA1, non-serous, and FIGO grade 1-2), 0/12 receiving adjuvant treatment recurred, while 1/12 not receiving adjuvant treatment recurred.

Surgically assessed stage IIIA endometrial adenocarcinoma recurs in approximately 20-25% of cases. A subset of stage IIIA1 with very low risk factors may be appropriate candidates for observation.