Gynecologic oncology 2003-12
Uterine papillary serous carcinoma (UPSC): a single institution review of 129 cases.
Abstract
Objective
The aim of this study was to identify clinical and pathologic characteristics of patients with uterine papillary serous carcinoma (UPSC) who were all surgically managed at a single institution. The identified characteristics were then correlated with overall survival (OS).
Methods
One hundred twenty-nine patients with FIGO stage I-IV UPSC who were surgically staged at the University of Texas M. D. Anderson Cancer Center between 1989 and 2002 were identified. For each patient, medical records and pathology reports were reviewed. The Kaplan-Meier method was used to generate OS data. Factors predictive of outcome were compared using the log-rank test and Cox regression analysis.
Results
There were 52 patients with stage I disease, 5 with stage II, 41 with stage III, and 31 with stage IV. The median age at the time of diagnosis was 68 years (range, 44-93 years). A personal history of breast cancer was reported by 12.4% of the patients, and a family history of breast cancer was reported by 16%. The 5-year OS among all patients was 45.9%. Among the stage I patients (IA, n = 19; IB, n = 26; and IC, n = 7), the 5-year OS was 62.9% (IA, 81.5%; IB, 58.6%; and IC, 34.3%). The 5-year OS for patients with stage III and IV disease was 37.3 and 19.9%, respectively. Pathologic features predictive of OS included lymph node status (P </= 0.01), lymph vascular invasion (P </= 0.05), and depth of uterine invasion (P </= 0.05). Among patients with no uterine invasion (n = 32), surgical staging revealed that 37% had stage III or IV disease. Among stage III patients, those who received chemotherapy had a longer OS than those who did not receive chemotherapy (P = 0.03).
Conclusion
In this population of nonselected patients with UPSC, approximately 20% had a personal or family history of breast cancer. Stage, lymph node status, lymph vascular invasion, and depth of myometrial invasion were all risk factors for a worse prognosis. Traditional risk factors, however, did not predict the presence or the absence of metastasis. Among patients with noninvasive uterine disease, there was a high proportion with abdominal metastasis. Therefore, complete surgical staging of these patients is vital in determining their prognosis.
Related Questions
Would you offer systemic chemotherapy to a patient with at least 2023 FIGO stage IC high grade serous (p53-mut) endometrial cancer with extensive LVI for whom nodal assessment was not done?
This question was addressed in a large NCDB study in 2020 by Nasioudis et al (Nasioudis et al., PMID 32675056) who looked at USC confined to the endometrium, which found that 5-year OS was 91% for chemo alone, 91% for chemoRT, 85% for those who received radiation alone, and 82% who were observed. Ad...
How do you manage early stage I uterine serous carcinoma?
The management of these patients remains controversial. The data are conflicting and treatment choices tend to be based more on impressions than solid data. Most clinicians advocate chemotherapy although randomized trials have not clearly shown benefit for this subset. For stage IA, we typically tre...