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An Assessment of Prognostic Factors, Adjuvant Treatment, and Outcomes of Stage IA Polyp-Limited Versus Endometrium-Limited Type II Endometrial Carcinoma
  1. Lusha W. Liang, BA*,
  2. Alexendar R. Perez, BA*,
  3. Nicholas A. Cangemi, BS,
  4. Qin Zhou, MA,
  5. Alexia Iasonos, PhD,
  6. Nadeem Abu-Rustum, MD§,
  7. Kaled M. Alektiar, MD and
  8. Vicky Makker, MD*,
  1. *Weill Cornell Medical College; and
  2. Gynecologic Medical Oncology Service, Department of Medicine,
  3. Epidemiology and Biostatistics,
  4. §Gynecologic Service, Department of Surgery, and
  5. Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
  1. Address correspondence and reprint requests to Vicky Makker, MD, Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. E-mail: makkerv@mskcc.org.

Abstract

Objective To determine clinical outcomes in patients with stage IA polyp-limited versus endometrium-limited high-grade (type II) endometrial carcinoma (EC).

Methods We identified all cases of stage IA polyp-limited or endometrium-limited high-grade EC (FIGO grade 3 endometrioid, serous, clear cell, or mixed) who underwent simple hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, omental biopsy, and pelvic and para-aortic lymph node dissection and received adjuvant treatment at our institution from October 1995 to November 2012. Progression-free survival (PFS) and overall survival (OS) by histology, adjuvant therapy, and polyp-limited versus endometrium-limited disease status were determined using log-rank test. We analyzed 3 treatment groups: patients who received chemotherapy with or without radiation therapy (RT) (intravaginal or pelvic); patients who received RT (intravaginal RT or pelvic RT) alone; and patients who received no adjuvant treatment.

Results In all, 85 women underwent hysterectomy/salpingo-oophorectomy; all were surgically staged with lymph node assessment and had stage IA EC with no lymphovascular or myometrial invasion. Median follow-up for survivors was 46.5 months (range, 1.98–188.8 months). Forty-nine patients (57.6%) had polyp-limited disease, and 36 (42.4%) had endometrium-limited disease. There were no significant differences in clinicopathologic characteristics between patients within the 3 treatment groups with regard to age at diagnosis, mean body mass index, ECOG (Eastern Cooperative Oncology Group) performance status, polyp-limited or endometrium-limited disease, diabetes, or race. The 3-year PFS rate was 94.9% and the 3-year OS rate was 98.8%. Univariate PFS and OS analysis revealed that age was a relevant prognostic factor (PFS hazard ratio [95% confidence interval], 1.13 [1.02–1.25]; P = 0.022; OS hazard ratio [95% confidence interval], 1.19 [1.02–1.38]; P = 0.03). Adjuvant treatment did not impact outcomes.

Conclusions Clinical outcomes of surgical stage IA type II polyp- or endometrium-limited high-grade epithelial EC are equally favorable regardless of histologic subtype or adjuvant therapy received. The benefit of adjuvant therapy in this select group remains to be determined.

  • Intravaginal radiation therapy
  • Radiation
  • Chemotherapy
  • Completely resected
  • Stage IA

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Footnotes

  • Lusha W. Liang and Alexendar R. Perez contributed equally to this article.

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