Incidence of adnexal involvement among patients with clinical stage I endometrioid endometrial adenocarcinoma

Abstract

Objectives: Evaluate the incidence and pathological factors associated with isolated adnexal involvement among patients with clinical stage I endometrioid endometrial adenocarcinoma undergoing hysterectomy. Methods: Patients without a history of another tumor diagnosed between 2010 and 2015 with clinical stage I endometrioid endometrial adenocarcinoma who underwent hysterectomy with bilateral salpingo-oophorectomy with known tumor grade, size, status of lymphovascular invasion (LVSI), peritoneal cytology and regional lymph nodes were selected from the National Cancer Database. Patients with adnexal metastases as the only site of intraperitoneal extra-uterine tumor spread were identified. Predictors of isolated adnexal involvement were identified with logistic regression. Overall survival (OS) of patients with and without adnexal involvement was compared with the log-rank test following generation of Kaplan-Meier curves. Results: A total of 17911 patients who met the inclusion criteria were identified; 161 (0.9%) had adnexal metastases. Incidence of adnexal metastases was lower for patients with grade 1 (0.6%) tumors compared to those with grade 2 (1%) and grade 3 (1.7%) tumors, p<0.001. Patients with adnexal metastases were more likely to have LVSI (50.3% vs 15.8%, p<0.001), positive peritoneal cytology (28.6% vs 5.2%, p<0.001) and positive lymph nodes (23.6% vs 3.7%, p<0.001). Incidence of adnexal metastasis was highest among patients with tumors ≥4 cm (1.6%) compared to those with tumors 2-4 cm (0.5%) and <2 cm (0.4%), p<0.001. Rate of adnexal metastasis among women <50 years was higher (2% vs 0.8%, p<0.001). By multivariate analysis, presence of positive peritoneal cytology (OR 4.90, 95% CI: 3.39, 7.07), LVSI (OR 3.01, 95% CI: 2.10, 4.31), lymph node metastasis (OR 2.85, 95% CI: 1.88, 4.32), tumor size >4 cm (OR 2.71, 95% CI: 1.47, 5.00) and age <50 years (OR 2.72, 95% CI: 1.85, 4.02) but not tumor grade were associated with adnexal metastasis. Three year OS rate for patients with adnexal involvement was 83% compared to 94.6% for those without, p<0.001 Conclusions: Isolated adnexal involvement is rare among patients with clinical stage I endometrioid endometrial adenocarcinoma, and correlated with worse overall survival. Presence of LVSI and positive peritoneal cytology were the strongest predictors of adnexal involvement. Evaluate the incidence and pathological factors associated with isolated adnexal involvement among patients with clinical stage I endometrioid endometrial adenocarcinoma undergoing hysterectomy. Patients without a history of another tumor diagnosed between 2010 and 2015 with clinical stage I endometrioid endometrial adenocarcinoma who underwent hysterectomy with bilateral salpingo-oophorectomy with known tumor grade, size, status of lymphovascular invasion (LVSI), peritoneal cytology and regional lymph nodes were selected from the National Cancer Database. Patients with adnexal metastases as the only site of intraperitoneal extra-uterine tumor spread were identified. Predictors of isolated adnexal involvement were identified with logistic regression. Overall survival (OS) of patients with and without adnexal involvement was compared with the log-rank test following generation of Kaplan-Meier curves. A total of 17911 patients who met the inclusion criteria were identified; 161 (0.9%) had adnexal metastases. Incidence of adnexal metastases was lower for patients with grade 1 (0.6%) tumors compared to those with grade 2 (1%) and grade 3 (1.7%) tumors, p<0.001. Patients with adnexal metastases were more likely to have LVSI (50.3% vs 15.8%, p<0.001), positive peritoneal cytology (28.6% vs 5.2%, p<0.001) and positive lymph nodes (23.6% vs 3.7%, p<0.001). Incidence of adnexal metastasis was highest among patients with tumors ≥4 cm (1.6%) compared to those with tumors 2-4 cm (0.5%) and <2 cm (0.4%), p<0.001. Rate of adnexal metastasis among women <50 years was higher (2% vs 0.8%, p<0.001). By multivariate analysis, presence of positive peritoneal cytology (OR 4.90, 95% CI: 3.39, 7.07), LVSI (OR 3.01, 95% CI: 2.10, 4.31), lymph node metastasis (OR 2.85, 95% CI: 1.88, 4.32), tumor size >4 cm (OR 2.71, 95% CI: 1.47, 5.00) and age <50 years (OR 2.72, 95% CI: 1.85, 4.02) but not tumor grade were associated with adnexal metastasis. Three year OS rate for patients with adnexal involvement was 83% compared to 94.6% for those without, p<0.001 Isolated adnexal involvement is rare among patients with clinical stage I endometrioid endometrial adenocarcinoma, and correlated with worse overall survival. Presence of LVSI and positive peritoneal cytology were the strongest predictors of adnexal involvement.