Improved Survival in Surgical Stage I Patients With Uterine Papillary Serous Carcinoma (UPSC) Treated With Adjuvant Platinum-Based Chemotherapy

Abstract

Between 1987 and 2004, 74 women with stage I uterine papillary serous carcinoma (UPSC) were surgically staged at Yale University School of Medicine. This retrospective review of these patients was performed to investigate the survival of patients according to adjuvant treatment with chemotherapy and/or brachytherapy, to histologic tumor classification (mixed [10-50% serous carcinoma] vs pure UPSC [more than 50% serous carcinoma]), and to diagnostic method (dilation and curettage [D&C] or office endometrial aspiration biopsy). All patients underwent complete surgical staging, including total abdominal hysterectomy, bilateral salpingooophorectomy, peritoneal cytology, bilateral pelvic lymphadenectomy, paraaortic lymph node sampling, and omentectomy. Adjuvant treatment at the beginning of the study was either observation or treatment with abdominopelvic radiation. Since the mid-1990s, platinum-based chemotherapy regimens with or without brachytherapy (high-dose vaginal cuff radiation) have been used. Nearly all (96%) patients were postmenopausal with an average length of menopause of 18 years. Fifty-five women (74%) were diagnosed by D&C and 19 (26%) had an office endometrial aspiration biopsy. Forty-seven women (64%) had pure UPSC and 27 women (36%) had mixed serous carcinoma. Stage IA disease was diagnosed in 33 patients (45%), stage IB in 29 (39%), and stage IC in 12 (16%). Twelve of the 33 stage IA patients had no residual cancer in the hysterectomy specimen and 21 were positive for residual uterine cancer. In all, 21 women had no adjuvant therapy (16 stage IA, four stage IB, and one stage IC) and were observed during follow up. Twelve patients (five stage IA, five stage IB, and two stage IC) underwent brachytherapy alone. One woman had a preoperative cesium application, and eight received external pelvic or whole abdominal radiation. Platinum-based chemotherapy was given to 31 of 32 women who received chemotherapy, including two stage IA patients with no residual uterine disease, seven stage IA patients with residual uterine disease, 16 stage IB patients, and seven stage IC patients. In addition, 26 women who received chemotherapy also had brachytherapy. With a median follow up of 38 months, none of the 12 stage IA patients who were negative for residual UPSC developed a recurrence of disease. Ten of these women were originally diagnosed by D&C, and two had office endometrial aspiration biopsy. Of the 21 patients who had stage IA disease with residual uterine carcinoma, no recurrences were seen in the seven who received chemotherapy, but six of the 14 patients who received no chemotherapy developed a recurrence of disease. Treatment with chemotherapy resulted in an improved disease-free survival (DFS) and improved overall survival (OS) for stage IA patients with uterine residual disease compared with those who had no chemotherapy (P <0.05 for both). There were no recurrences in the follow-up period (median, 37 months) among the 15 stage IB patients who received platinum-based chemotherapy. Of 13 stage IB patients who did not have adjuvant chemotherapy, 10 patients recurred. The remaining three patients were disease free at 36, 73, and 132 months. Treatment with chemotherapy significantly improved the survival in stage IB patients (DFS and OS P <0.01 for both). Among the 12 patients with stage IC disease, one of the seven who received chemotherapy and four of the five who had no chemotherapy developed a recurrence of disease (DFS and OS, P <0.01 for both). The median follow up for the seven patients without recurrences was 57 months. Overall, the 5-year survival rate for stage I patients was 100% in those who received adjuvant chemotherapy and 46% for those with no chemotherapy. There were a total 21 recurrences among the 74 patients with UPSC. Of the 43 patients who did not receive chemotherapy, 20 (47%) recurred. Six of 21 (29%) women who did not have any adjuvant therapy recurred, including four at the vaginal cuff, two