The role of optimal debulking in advanced stage serous carcinoma of the uterus

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Objective. To evaluate the role of optimal surgical cytoreduction and postoperative therapy in women with advanced uterine serous carcinoma (USC). Methods. A multi-institutional, retrospective review identified 52 women with stage IV USC. Patient factors, surgical findings, and follow-up data were collected. Differences in demographics, surgical treatments, and adjuvant therapies administered were assessed with Fisher's exact test. Analysis of survival was performed using Kaplan-Meier and comparisons of survival were made using the log-rank test. Results. Twenty-six women were optimally debulked (≤1 cm residual) and 23 were suboptimally debulked. Three women underwent biopsies for pathologic confirmation and were included in the suboptimal group. There was no difference in demographic characteristics, clinical symptoms, postoperative complications, or mortality between the two groups. Median CA-125 level at presentation was not statistically different between the two groups ( P > 0.05). Median survival was longer in the optimal group (15 vs. 8 m), however, this did not reach statistical significance ( P > 0.05). Women who received adjuvant platinum-based chemotherapy had a longer median survival than those who did not receive platinum chemotherapy (21 vs. 2 m) ( P < 0.0001). Optimal cytoreduction combined with adjuvant therapy demonstrated a trend toward prolonged survival when compared to suboptimal cytoreduction combined with adjuvant therapy. However, the results did not achieve statistical significance ( P > 0.05). Conclusion. Although no clear survival advantage is shown in the women who underwent optimal versus suboptimal debulking, there was a trend towards longer median survival in those who were maximally cytoreduced. Adjuvant platinum-based chemotherapy is associated with significantly longer survival in all women, regardless of amount of residual disease.