Does Lower Uterine Segment Involvement in Grade 3 Endometrial Cancer Impact Recurrence Patterns and Patient Outcomes

Abstract

Background: The aim of the study was to determine the impact of lower uterine segment (LUS) on progression free survival (PFS), recurrence patterns and outcomes in women with high-grade endometrial cancer. Methods: A single-institution, retrospective cohort study was performed to evaluate the impact of LUS involvement in women with stage I-III high-grade endometrial cancer diagnosed between January 2005 and September 2010. Clinical and pathology data were collected from electronic medical records. Univariate tests and multivariate Cox modeling were applied. Results: Of 282 cases, 48.6% (137/282) were LUS-positive. Body mass index, age, hypertension and diabetes did not differ by LUS status. LUS involvement was associated with lymphovascular space invasion (LVSI) (52.9% vs. 30.5%, P < 0.001), deep myometrial invasion (48.9% vs. 24.1%, P < 0.001), and nodal metastases (38.7% vs. 11.6%, P < 0.001). Even after adjusting for obesity, deep myometrial invasion, LVSI, nodal status, stage, histology, and adjuvant therapy, LUS-positive cases had significantly worse PFS (HR 1.83, 95% CI 1.11 - 3.02, P = 0.02). LUS-positive cases recurred more frequently despite adjuvant therapy including radiation, chemotherapy or both. Recurrence patterns did not differ by LUS status (P = 0.22). Conclusions: LUS involvement in high-grade endometrial cancers is associated with worse PFS independent of other poor prognostic factors. Future studies evaluating volume-directed therapy may improve patient outcomes. J Clin Gynecol Obstet. 2014;3(3):85-92 doi: http://dx.doi.org/10.14740/jcgo264w