A multivariate analysis on histopathologic prognostic factors for predicting outcome of node-positive endometrial carcinoma

Abstract

5064 Background: Prognosis of advanced endometrial cancer patients (stage IIIc and IV) is poor. In order to clarify the histopathologic prognostic factors of node-positive endometrial cancer, we performed the following analysis. Methods: A retrospective review of 55 node-positive endometrial cancer patients (44 in stage IIIc and 11 in stage IV) among 303 patients treated between 1982 and 2002 at Hokkaido University Hospital was performed. All Patients underwent primary surgical treatment including pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy consisting of intravenous cisplatin, doxorubicin, and cyclophoshamide. Survival analyses were performed by the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by multivariate Cox regression analysis. Results: Multivariate analysis revealed that FIGO (1988) stage and lymph-vascular space invasion (LVSI) of the tumor were found to be independently related to poor survival . The estimated 5-year survival rate of stage IIIc patients with or without moderate/prominent LVSI was 50.9 % and 93.3 %, respectively. The difference of survival rate was statitstically significant (p=0.0024). The estimated 5-year survival rate of stage IV patients was 20.0%. In stage IIIc patients, multivariate analysis showed that LVSI alone was found to be an independent prognostic factor for survival. Prognosis of stage IIIc patients could be stratified into three groups by the number of positive para-aortic lymph node (PAN) with an estimated 5-year survival rate of 86.4% for no positive PAN (n=23), 60.4% for 1 positive PAN (n=13), 20.0% for >=2 positive PAN (n=8). The difference of survival rate between no or one positive PAN and >=2 PAN was statistically significant (p=0.0007 for no positive PAN vs >=2 PAN, p=0.0319 for one positive PAN vs >=2 positive PAN). Conclusions: LVSI was an independent prognostic factor for stage IIIc patients and their prognosis was stratified by the number of positive PAN. Postoperative therapy and follow-up modality need to be individualized according to LVSI and the number of positive PAN for stage IIIc patients. No significant financial relationships to disclose.