Clinical characteristics and outcomes of women with stage IV endometrial cancer

Treatment strategies for patients with stage IV endometrial cancer (EC) remain controversial. Some studies have suggested that optimal cytoreduction improves survival. We retrospectively analyzed the clinical characteristics and outcomes of 41 women with stage IV EC. The results of preoperative cytologic evaluation and biopsy of the endometrium were reviewed by a single pathologist for patients in whom stage IV EC was diagnosed preoperatively. Of the 41 patients with stage IV EC (median age, 62 years), 31 had surgical stage IV disease and 10 had clinical stage IV disease. Twenty-eight patients were diagnosed of stage IV EC before surgery or without surgery. Progression-free survival and overall survival were 10.4 and 21.3 months, respectively. On univariate analysis, grade 1 or 2 endometrioid subtype, 0 or 1 sites of extraperitoneal metastasis, and hormonal therapy were associated with good outcomes. Multivariate analysis revealed that grade 1 or 2 endometrioid subtype (P=0.005, hazard ratio [HR] 0.23 [0.08-0.65]) and 0 or 1 sites of extraperitoneal metastasis (P=0.001, HR 0.24 [0.10-0.57]) were independent predictors of survival. Neither surgery as primary therapy nor optimal cytoreduction was significantly related to overall survival in either the 28 patients in whom stage IV was diagnosed preoperatively or in all 41 patients. In women with stage IV EC, histologic features and extent of disease are more important determinants of outcomes than any kind of treatment. The indication for surgery should be carefully considered in this subset of patients.