Outcome after combined modality treatment for uterine papillary serous carcinoma (UPSC): A Rare Cancer Network (RCN) Multicenter Study

Abstract

5078 Background: There are no established guidelines for treatment of UPSC, either in the adjuvant setting or in advanced disease. The aim of this retrospective, multi-center study was to analyze the outcome of pts.with UPSC treated with combined modalities. Methods: This was a cooperative study within the framework of the RCN. Charts of patients with UPSC diagnosed between 1980 - 2003 were reviewed. Pts were followed for 3–294 months (Median 35). Treatment included surgery, chemotherapy, and/or radiation therapy (RT) according to discretion of treating physician. Results: Sixty-eight pts, 37–85 yrs (median 67) were included. Histology features: mixed histology (containing UPSC elements and typical adenocarcinoma)and pure UPSC were found in 18 pts (26%), and in 50 pts (74%) respectiviely. Stage distribution: stage I 26 pts (38%), II 12 pts (18%), III 16 pts (24%), IV 13 pts (19%), no data 1 pt. Sixty-five pts had surgery, 3 pts biopsy only, 30 pts (44%) treated with RT in an adjuvant setting. Five pts irradiated for palliation, and 2 for pelvic recurrence. 29 pts (43%) received platinum-based adjuvant chemotherapy (CT). In 28 pts CT was given for persisting disease, resulting in 54% response rate (5 complete and 10 partial responders). 20 pts (29%) are alive and NED, 3 alive with disease, 35 died of disease, 9 (13%) died of other causes, and one died of toxicity. Five-year Disease specific survival (DSS) rates as follows: All pts (N=68) 46%, mixed type pathology 84%, pure UPSC 35% (p<0.0001), stage 1&2 72%, stage 3&4 13% (p<10-6), pts receiving CT 50%, no CT 56% (NS), pts receiving RT 55%, no RT 51% (NS). 5 yr disease free survival rates as follows: all pts 40%, mixed type 82%, pure UPSC 27% (p<10-6), stages 1&2 62%, stages 3&4 6% (p<10-6), pts receiving CT 39%, no CT 51% (NS), pts receiving RT 58%, no RT 34% (p<0.021). In a Cox regression analysis for DSS, stages (HR 4.7) and pathology subtype (HR 4.6) were found highly significant. CT and RT not significant. RT did not make any difference in pelvic recurrence rate. Conclusions: 1.Stage of disease and pathology subtype are significant prognostic factors. 2. Results do not support any benefit from either chemotherapy or radiotherapy in the adjuvant setting. No significant financial relationships to disclose.