TY - JOUR
T1 - Lower uterine segment involvement is associated with adverse outcome in patients with stage I endometroid endometrial cancer
T2 - Results of a multicenter study
AU - Gemer, O.
AU - Gdalevich, M.
AU - Voldarsky, M.
AU - Barak, F.
AU - Ben Arie, A.
AU - Schneider, D.
AU - Levy, T.
AU - Anteby, E. Y.
AU - Lavie, O.
PY - 2009/8/1
Y1 - 2009/8/1
N2 - Objective: To quantify the relative risk associated with lower uterine segment involvement (LUSI) on outcome measures in patients with apparent stage I endometroid endometrial cancer. Methods: A cohort of 769 consecutive patients with endometroid endometrial carcinoma apparent stage I, who underwent surgery in five gynecological oncology centers in Israel; 138 patients with and 631 without LUSI were followed for a median time of 51 months. Local recurrence, recurrence-free and overall survival were compared between the two groups. Results: LUSI was associated with grade 3 tumor (p = 0.002), deep myometrial invasion (p < 0.001), and the presence of lymphvascular space involvement (p = 0.01). There were 22 cases of local recurrences, 40 cases of distal recurrences and 80 patients died. Univariate survival analysis showed that patients with LUSI had trend toward lower regional recurrence-free survival (p = 0.09), and significant lower distant recurrence-free survival (p = 0.04) and lower overall survival (p = 0.002). The Cox proportional hazards model demonstrated a significantly decreased overall survival (HR = 2.3; 95% CI 1.3, 3.9; p = 0.003) in cases with LUSI. Conclusions: In patients with apparent stage I endometroid endometrial cancer, the presence of LUSI is a poor prognostic factor, associated with a significantly higher risk of distal recurrence and death. The presence of LUSI warrants consideration when deciding upon surgical staging or postoperative management.
AB - Objective: To quantify the relative risk associated with lower uterine segment involvement (LUSI) on outcome measures in patients with apparent stage I endometroid endometrial cancer. Methods: A cohort of 769 consecutive patients with endometroid endometrial carcinoma apparent stage I, who underwent surgery in five gynecological oncology centers in Israel; 138 patients with and 631 without LUSI were followed for a median time of 51 months. Local recurrence, recurrence-free and overall survival were compared between the two groups. Results: LUSI was associated with grade 3 tumor (p = 0.002), deep myometrial invasion (p < 0.001), and the presence of lymphvascular space involvement (p = 0.01). There were 22 cases of local recurrences, 40 cases of distal recurrences and 80 patients died. Univariate survival analysis showed that patients with LUSI had trend toward lower regional recurrence-free survival (p = 0.09), and significant lower distant recurrence-free survival (p = 0.04) and lower overall survival (p = 0.002). The Cox proportional hazards model demonstrated a significantly decreased overall survival (HR = 2.3; 95% CI 1.3, 3.9; p = 0.003) in cases with LUSI. Conclusions: In patients with apparent stage I endometroid endometrial cancer, the presence of LUSI is a poor prognostic factor, associated with a significantly higher risk of distal recurrence and death. The presence of LUSI warrants consideration when deciding upon surgical staging or postoperative management.
KW - Endometrial cancer
KW - Lower uterine segment
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=67649289906&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2008.10.007
DO - 10.1016/j.ejso.2008.10.007
M3 - Article
C2 - 19013746
AN - SCOPUS:67649289906
SN - 0748-7983
VL - 35
SP - 865
EP - 869
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 8
ER -
