Minimally Invasive Technique Not Associated with Worse Prognosis in Patients with Stage I Uterine Papillary Serous Carcinoma (UPSC)

Abstract

Study Objective To determine the role of surgical technique in increasing risk of recurrence in patients with stage I UPSC. Design Using a prospective database and billing records, all cases of UPSC were identified from 2006 through 2021. Standard statistical analysis related the impact of surgical technique and BTL on recurrence risk and progression free survival (PFS) in patients with stage I UPSC. Setting N/A. Patients or Participants All patients with UPSC diagnosed at our center 2006-2021. Interventions N/A. Measurements and Main Results A total of 225 total cases of UPSC were identified, including 118 pts with stage I disease. Six patients (5%) had endometrial intraepithelial carcinoma (EIC), 98 (83%) were stage IA, and 14 (12%) were stage IB. A history of BTL was obtained in 25 pts (21%). Minimally invasive hysterectomy was performed in 99 (84%; 31% robot, 53% laparoscopy). Adjuvant chemotherapy was given to 83 patients (72%) with 31 (256%) receiving 3 cycles or less and 54 (46%) receiving 4-7 cycles. Additionally, 22 (19%) received vaginal brachytherapy and 9 (8%) received whole pelvic radiation. Seventeen patients (14%) experienced recurrence after treatment and 8 (7%) died of disease. No differences in PFS or outcomes were noted between open and minimally invasive methods (P=0.76). Patients who underwent BTL prior to diagnosis were found to have a recurrence rate of 28% vs. 11% in patients without history of BTL (P = 0.03). A multivariate model incorporating known risk factors for recurrence, including use of radiation, chemotherapy, depth of invasion, and LVSI, confirmed that BTL remained a significant predictor of recurrence (OR 3.18; 95% CI 1.02-9.96, P = 0.046). Conclusion No differences in progression free survival were noted between patients who underwent minimally invasive vs. open surgeries in patients with stage I UPSC. However, BTL does not appear to be protective against extra-uterine spread and may change the presenting stage of biologically more aggressive tumors. To determine the role of surgical technique in increasing risk of recurrence in patients with stage I UPSC. Using a prospective database and billing records, all cases of UPSC were identified from 2006 through 2021. Standard statistical analysis related the impact of surgical technique and BTL on recurrence risk and progression free survival (PFS) in patients with stage I UPSC. N/A. All patients with UPSC diagnosed at our center 2006-2021. N/A. A total of 225 total cases of UPSC were identified, including 118 pts with stage I disease. Six patients (5%) had endometrial intraepithelial carcinoma (EIC), 98 (83%) were stage IA, and 14 (12%) were stage IB. A history of BTL was obtained in 25 pts (21%). Minimally invasive hysterectomy was performed in 99 (84%; 31% robot, 53% laparoscopy). Adjuvant chemotherapy was given to 83 patients (72%) with 31 (256%) receiving 3 cycles or less and 54 (46%) receiving 4-7 cycles. Additionally, 22 (19%) received vaginal brachytherapy and 9 (8%) received whole pelvic radiation. Seventeen patients (14%) experienced recurrence after treatment and 8 (7%) died of disease. No differences in PFS or outcomes were noted between open and minimally invasive methods (P=0.76). Patients who underwent BTL prior to diagnosis were found to have a recurrence rate of 28% vs. 11% in patients without history of BTL (P = 0.03). A multivariate model incorporating known risk factors for recurrence, including use of radiation, chemotherapy, depth of invasion, and LVSI, confirmed that BTL remained a significant predictor of recurrence (OR 3.18; 95% CI 1.02-9.96, P = 0.046). No differences in progression free survival were noted between patients who underwent minimally invasive vs. open surgeries in patients with stage I UPSC. However, BTL does not appear to be protective against extra-uterine spread and may change the presenting stage of biologically more aggressive tumors.