687 Advanced endometrial cancer surgery: what really impacts on survival?

Abstract

<h3>Introduction/Background*</h3> Endometrial cancer is the most common gynecological malignancy and its incidence is increasing steadily. More than 10% of cases will present with advanced stage disease. In these patients, the role and the time of surgery needs further clarification. <h3>Methodology</h3> Retrospective analysis of all advanced endometrial cancer cases treated in our department from 2012 to 2018 was performed. Demographic and clinical variables were collected. Charlson comorbidity index was used to assess comorbidity. The use of neoadjuvant chemotherapy and the type of cytoreductive surgery (primary or interval debulking), surgical variables and residual disease after cytoreduction (no macroscopic disease, optimal cytoreduction &lt;1cm, residual &gt;1cm or unresectable disease) were reported. Tumor characteristics were retracted from pathology reports. Descriptive statistics were used to present patients’ and disease characteristics, as well as Kaplan- Maier curves for disease free survival and overall survival curves were estimated. <h3>Result(s)*</h3> Records from 45 patients with stage IIIC and IV endometrial cancer between 2012 and 2018 were retracted. In our records, 35 (78%) patients were treated with primary debulking and 10 (22%) with neoadjuvant chemotherapy and interval debulking, because of primary inoperable tumor. Patients were staged as IIIC1 (13/45) IIIC2 (13/45) and IVa (1/45) and IVb (18/45). Complete or optimal debulking (primary or interval) was achieved in 31/45 patients (69%), while residual or unresectable disease was recorded in 14/45 (31%). Median overall survival was 38 months. Specifically, median overall survival in patients with complete cytoreduction (RD 0) was &gt; 96 months and 41 months in patients with optimal cytoreduction (RD &lt;1). However, patients with residual disease &gt;1cm had a median overall survival of 7 months. RD &lt; 1 showed a 4,67 increased risk for death (p: 0.012) and R&gt;1 showed a 12,2-fold (p&lt;0,01) increased risk for death compared to complete cytoreduction. Age and ca- 125 at diagnosis and Charlson comorbidity index did not seem to have an impact on survival. <h3>Conclusion*</h3> Complete cytoreduction is the most important factor which influences survival in advanced endometrial cancer patients.