Implication of new figo surgical staging on patterns of failure and survival in endometrial carcinoma

Continued emphasis on treating endometrial cancer primarily as a surgical disease has led to the institution, in 1988, of a new staging system based on operative findings. Since the system is new, limited experience has been published confirming its theoretical advantage in predicting clinical outcome. In a four year period, 117 patients with newly diagnosed endometrial cancer were referred for adjuvant radiation therapy to the Department of Radiation Oncology. All patients were restaged based on surgical findings according to the revised 1988 FIGO Staging System. This requires an assessment of peritoneal washings, myometrial invasion, cervical involvement, adnexal and pelvic/para-aortic lymph node metastasis. 39 patients were excluded, leaving 78 patients who were distributed in each stage as follows: Stage I-39 pts (IA 2 pts, IB 24 pts, IC 13 pts), Stage II-10 pts (IIA 5 pts, IIB 5 pts), Stage III-21 pts (IIIA 6 pts, IIIB 1 pt, IIIC 14 pts). and Stage IV-8 pts (IVA 1 pt, IVB 7 pts). The median follow-up time was 40 months, ranging from 3-82 months. The three year absolute and disease-free survival in each stage were: Stage I-97% and 97%, Stage II-79% and 80%, Stage III-37% and 24%, and Stage IV-13% and 0%, respectively. The locoregional and distant failure rates were: Stage I-3% and 5%, Stage II-20% and 0%, Stage III-10% and 76%, respectively. This retrospective analysis suggests that the survival and distant failure are well predicted by the revised FIGO Staging System, which relies completely on findings at surgical staging.