Ovarian Preservation and Staging in Reproductive-Age Endometrial Cancer Patients

Abstract

The prognosis for premenopausal women with early stage endometrial carcinoma is favorable, with a 5-year survival rate greater than 90%. For more than 20 years, standard treatment has been aggressive surgical staging consisting of total abdominal hysterectomy and bilateral salpingo-oophorectomy (BSO) with pelvic and paraaortic lymphadenectomy as needed. Surgical staging in premenopausal women is associated with significant morbidity from lymphadenectomy, and long-term adverse effects in cardiovascular and bone health from premature menopause as well as in quality of life. Investigators have explored the possibility of less aggressive treatment in young, early-stage patients with endometrial cancer using a clinical staging regimen that preserves the ovary and employs limited surgical staging. This regimen appears feasible for young women with early stage endometrial cancer—a patient population at low risk of lymph node metastases and distant spread. This retrospective study compared outcomes of complete surgical and clinical staging, including the impact of ovarian preservation in young patients with endometrial carcinoma. Medical charts were reviewed for all patients with endometrial cancer at age 45 or younger diagnosed and treated from 1960 to 2006 at a large university hospital. Data on clinical findings, histology, epidemiology and history were examined and a gynecologic pathologist reviewed the histological slides. The mean age of the 251 study subjects was 41 years (range: 23-45 years). Stage 1 disease was identified in over 75% of the patients. Surgical staging was used in 146 patients (58.2%), whereas clinical staging was performed in 101 patients (40.2%). Most of the 251 patients (80%) had a BSO. Recurrence was diagnosed in less than 3% of the patients. Women with grade 1 disease who underwent surgical staging had a significantly longer overall survival than clinically staged patients (P = 0.003). No difference in disease-free survival, however, was found between the 2 groups. Compared to patients with ovarian preservation, those who underwent a BSO had a trend toward longer disease-free survival when all patients were included. Women with stage I disease who underwent a BSO had a significantly longer disease-free survival (P = 0.013). The investigators conclude from these findings that clinical staging in young women with early stage low-grade endometrial cancer may be a useful alternative in the absence of risk factors to aggressive surgical staging. Strong consideration should be given, however, to include BSO as part of the surgical regimen.