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Neoadjuvant Chemotherapy Versus Primary Cytoreductive Surgery for Stage IV Uterine Serous Carcinoma
  1. Ivy Wilkinson-Ryan, MD*,
  2. Antonina I. Frolova, MD, PhD*,
  3. Jingxia Liu, PhD,
  4. L. Stewart Massad, MD*,
  5. Premal H. Thaker, MD*,
  6. Matthew A. Powell, MD*,
  7. David G. Mutch, MD* and
  8. Andrea R. Hagemann, MD*
  1. *Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and
  2. Division of Biostatistics, Washington University School of Medicine, St Louis, MO.
  1. Address correspondence and reprint requests to Ivy Wilkinson-Ryan, MD, 4911 Barnes-Jewish Hospital Plaza, Campus Box 8064, St Louis, MO 63110. E-mail: ivywilkry{at}


Objective This study compares surgical and survival outcomes of women with stage IV uterine serous carcinoma (USC) treated with neoadjuvant chemotherapy (NAC) and interval cytoreduction to women treated with primary cytoreductive surgery (PCS) followed by adjuvant chemotherapy.

Methods This retrospective dual cohort study included women diagnosed with stage IV USC at a single academic institution. Kruskal-Wallis and Fisher exact tests were used to compare demographics and surgical outcomes. Progression-free survival (PFS) and overall survival (OS) were estimated by using Kaplan-Meier methods. Comparison between study groups was tested by log-rank statistics.

Results Ten women with stage IV USC who received NAC and 34 who underwent PCS met inclusion criteria. Neoadjuvant chemotherapy patients had a lower mean body mass index and were more often African American. Compared with PCS, the NAC cohort had shorter mean operative times (137 ± 66 vs 203 ± 80 minutes, P = 0.025) and were discharged from the hospital earlier (median length of stay, 3 vs 5 days; P = 0.002). Rates of debulking to no gross residual disease (70% NAC vs 32.3% PCS) or less than 1 cm of disease (30% NAC vs 50% PCS) did not differ (P = 0.10). Median follow-up time was 17.5 months. There was no difference in median PFS (10.4 vs 12 months, P = 0.29) or OS (17.3 vs 20.7 months, P = 0.23) for NAC and PCS cohorts.

Conclusions Women receiving NAC for stage IV USC had shorter surgeries and hospital stays than did those receiving PCS. There was no difference in PFS or OS, although our sample size was small. Neoadjuvant chemotherapy may be an appropriate therapy for select patients with advanced-stage USC.

  • Uterine serous carcinoma
  • Neoadjuvant chemotherapy
  • Endometrial carcinoma

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  • This study was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

  • The authors declare no conflicts of interest.