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2009 International Federation of Gynecology and Obstetrics (FIGO) stage IIIA endometrial cancer: oncologic outcomes based on involvement of adnexa, serosa, or both
  1. Eric Rios-Doria1,
  2. Nadeem R Abu-Rustum2,3,
  3. Gretchen Glaser4,
  4. Michaela McGree5,
  5. Ane Gerda Eriksson6,7,
  6. Melissa Pham8,
  7. Pamela Soliman8,
  8. Beyhan Ataseven9,10,
  9. Kaled Alektiar11,
  10. Dmitriy Zamarin12,
  11. Mario L Leitao Jr2,3 and
  12. Jennifer Mueller2,3
    1. 1 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
    2. 2 Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
    3. 3 Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
    4. 4 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
    5. 5 Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
    6. 6 Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo, Norway
    7. 7 Faculty of Clinical Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
    8. 8 Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
    9. 9 Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
    10. 10 Department of Gynecology, Gynecologic Oncology and Obstetrics, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe, Detmold, Germany
    11. 11 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
    12. 12 Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
    1. Correspondence to Dr Jennifer Mueller, Memorial Sloan Kettering Cancer Center, New York 10065, New York, USA; muellerj{at}mskcc.org

    Abstract

    Objective To assess clinicopathologic features and survival outcomes of patients with endometrial carcinoma involving adnexal, full-thickness serosal, or combined involvement.

    Methods This international, multi-institutional, retrospective study examined patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IIIA endometrial cancer and tumors involving the uterine serosa and/or adnexa, who were surgically staged between 2000 and 2019. Patients with sarcoma histology, concurrent endometrial/ovarian malignancy, neoadjuvant treatment, positive lymph nodes, or peritoneal disease were excluded.

    Results Of 185 patients identified, 139 had tumors with adnexal-only, 40 with serosal-only, and six with combined adnexal/serosal involvement. Median age at diagnosis was 60 years (range 23–89). Among tumors of endometrioid histology, 12 (48%) with serosal-only and 17 (19%) with adnexal-only involvement were FIGO grade 3 (p=0.007). Twenty-three tumors with serosal-only (64%) and 50 with adnexal-only (37%) involvement had lymphovascular invasion (p=0.004). Non-endometrioid histology was present in five tumors (83%) with combined adnexal/serosal, 15 (38%) with serosal-only, and 50 (36%) with adnexal-only involvement.

    Median follow-up was 77 months (range 0.6–254). Five-year progression-free survival and overall survival rates for all patients with stage IIIA disease were 73.8% (SE 3.5%) and 81.0% (SE 3.1%), respectively. For patients with adnexal-only, serosal-only, and combined adnexal/serosal involvement, 5-year progression-free survival rates were 80% (SE 3.8%), 61% (SE 8.3%), and 33% (SE 19.2%), respectively (p<0.01); 5-year overall survival rates were 85% (SE 3.3%), 70% (SE 7.8%), and 60% (SE 21.9%), respectively (p=0.09). On univariate analysis, tumors having serosal involvement with/without adnexal involvement, non-endometrioid histology, and lymphovascular invasion were significantly associated with progression. On multivariate analysis, tumors having serosal involvement with/without adnexal involvement remained significantly associated with recurrence (adjusted HR=2.2, 95% CI 1.2 to 4.3; p=0.01).

    Conclusions Patients with 2009 FIGO stage IIIA endometrial cancer have distinct survival outcomes depending upon adnexal and/or serosal involvement. Progression-free survival was worse for patients with serosal involvement after adjusting for histology, adjuvant treatment, and lymphovascular space invasion.

    • Uterine Cancer
    • Adnexal Diseases

    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

    https://doi.org/10.1136/ijgc-2024-005567

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      Data availability statement

      Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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      Footnotes

      • X @RiosDoriaMD, @agz_eriksson, @PamSolimanMD, @leitaomd

      • Contributors ER-D: conceptualization, data curation, formal analysis, methodology, writing – original draft, writing – review and editing. NRA-R, GG, MM, AGE, PS, BA, KA, DZ, MP : writing – review and editing. ML: conceptualization, formal analysis, methodology, writing – review and editing. JM: conceptualization, data curation, formal analysis, methodology, writing – original draft, writing – review and editing, guarantor.

      • Funding This research was funded in part by the National Institutes of Health (NIH)/National Cancer Institute (NCI) Cancer Center Support Grant P30 CA008748.

      • Competing interests ML reports personal fees from Medtronic, Intuitive Surgical, J&J/Ethicon, and Immunogen. NRA-R reports research funding paid to the institution from GRAIL. AGE reports speaker fees from Intuitive Surgical and AstraZeneca. DZ reports institutional research support from AstraZeneca, Merck, Plexxikon, Synthekine, and Genentech; consulting fees from AstraZeneca, Synthekine, Astellas, Tessa Therapeutics, Memgen, Celldex, Crown Biosciences, Hookipa Biotech, Kalivir, Xencor, and GSK; royalties from Merck; and stock options from Accurius Therapeutics, ImmunOS Therapeutics, and Calidi Biotherapeutics, all outside the submitted work. The other authors do not have potential conflicts of interest to declare.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.