J Gynecol Oncol.  2015 Jan;26(1):25-31. 10.3802/jgo.2015.26.1.25.

An analysis of current treatment practice in uterine papillary serous and clear cell carcinoma at two high volume cancer centers

• Vogel TJ
• Knickerbocker A
• Shah CA
• Schiff MA
• Isacson C
• Garcia RL
• Goff BA

• KMID: 2158799
• DOI: http://doi.org/10.3802/jgo.2015.26.1.25

Abstract

OBJECTIVE
Despite the rarity of uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCCC), they contribute disproportionately to endometrial cancer deaths. Sufficient clinical information regarding treatment and prognosis is lacking. The aim of this study is to evaluate treatment outcomes in a rare cancer cohort based on the experience at two tertiary care cancer centers.
METHODS
Clinicopathologic data were retrospectively collected on 279 patients with UPSC and UCCC treated between 1995 to 2011. Mode of surgery, use of adjuvant treatment, and dissection of paraaoritc lymph nodes were evaluated for their association with overall survival (OS) and progression-free survival (PFS).
RESULTS
40.9% of patients presented with stage I disease, 6.8% of patients presented with stage II disease and 52.3% of patients presented with stages III and IV. Median follow-up was 31 months (range, 1 to 194 months). OS and PFS at 5 years were 63.0% and 51.9%, respectively. OS and PFS were not affected by mode of surgery (open vs. robotic approach; OS: hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.28 to 1.62; PFS: HR, 0.78; 95% CI, 0.40 to 1.56). Adjuvant treatment was associated with improved OS in stages IB-II (HR, 0.14; 95% CI, 0.02 to 0.78; p=0.026) but not in stage IA disease. There was no difference in OS or PFS based on the performance of a paraaoritc lymph node dissection.
CONCLUSION
Minimally invasive surgical staging appears a reasonable strategy for patients with non-bulky UPSC and UCCC and was not associated with diminished survival. Adjuvant treatment improved 5-year survival in stages IB-II disease.

Keyword

Adenocarcinoma, Clear Cell; Disease-free Survival; Endometrial Neoplasms; Lymph Node Excision; Retrospective Studies

MeSH Terms

Adenocarcinoma, Clear Cell/pathology/secondary/*therapy
Aged
Chemotherapy, Adjuvant
Cystadenocarcinoma, Papillary/pathology/secondary/*therapy
Cystadenocarcinoma, Serous/pathology/secondary/*therapy
Female
Humans
Lymph Node Excision
Lymphatic Metastasis
Middle Aged
Neoplasm Staging
Professional Practice
Radiotherapy, Adjuvant
Retrospective Studies
Robotic Surgical Procedures
Survival Analysis
Treatment Outcome
Uterine Neoplasms/pathology/*therapy

Figure

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  Fig. 1 Overall survival in stages IB-II patients with uterine papillary serous carcinoma and clear cell carcinoma with and without adjuvant therapy.

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