Clinical stage i endometrial cancer: Prognostic factors for local control and distant metastasis and implications of the new figo surgical staging system

Perry W. Grigsby, Carlos A. Perez, Abraham Kuten, Joseph R. Simpson, Delia M. Garcia, H. Marvin Camel, Ming Shian Kao, Andrew E. Galakatos

Research output: Contribution to journalArticlepeer-review

114 Scopus citations

Abstract

A retrospective analysis is reported in 858 patients with clinical Stage I carcinoma of the endometrium treated definitively with combined irradiation and total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) from January 1960 through December 1986. Most patients received a preoperative intracavitary insertion (3500-4000 mgh to the uterus and a 6500 cGy surface dose to the upper vagina) followed by a TAH-BSO within 1-2 weeks. Some patients received postoperative external beam irradiation (2000 cGy whole pelvis and an additional 3000 cGy to the parametria, with a midline stepwedge) when factors such as deep myometrial invasion were present. Occasionally patients were treated with a preoperative intracavitary insertion and preoperative external beam irradiation (2000 cGy whole pelvis). The 5-year progression-free survivals by FIGO (1988) surgical stage were 93% for IA, 90% for IB, and 91% for Stage 1C. An analysis of multiple variables was performed to ascertain their prognostic significance. Factors that significantly affected the 5-year progression-free survivals by univariate analysis were grade (grade 1 = 95%, grade 2 = 88%, grade 3 = 73%; p < 0.0001 histology (adenoacanthoma = 96%, clear cell = 89%, adenocarcinoma = 89%, papillary = 81%, adenosquamous = 80%; p = 0.04), lower uterine segment involvement (uninvolved = 89%, involved = 73%; p = 0.006), depth of myometrial invasion (no residual tumor = 91%, limited to the endometrium = 96%, < 1 3 myometrial penetration = 92%, 1 3-23 = 100%, > 2 3 = 50%; p = 0.02), peritoneal cytology (negative = 92%, positive = 56%; p < 0.0001), uterine serosal involvement (uninvolved = 89%, involved = 55%; p < 0.0001), vascular space invasion (absent = 89%, present = 75%; p = 0.001), and the presence of extrauterine disease (absent = 90%, present = 64%; p < 0.0001). A multivariate analysis of these prognostic variables showed that histological grade (p = 0.001), peritoneal cytology (p = 0.004), and uterine serosal involvement were prognostic for local failure and that peritoneal cytology (p < 0.001), grade (p = 0.001), age (p = 0.002), and extrauterine disease (p = 0.02) were prognostic for the development of distant metastasis.

Original languageEnglish
Pages (from-to)905-911
Number of pages7
JournalInternational journal of radiation oncology, biology, physics
Volume22
Issue number5
DOIs
StatePublished - 1992

Keywords

  • Brachytherapy
  • Endometrial carcinoma
  • Preoperative irradiation

Fingerprint

Dive into the research topics of 'Clinical stage i endometrial cancer: Prognostic factors for local control and distant metastasis and implications of the new figo surgical staging system'. Together they form a unique fingerprint.

Cite this