Role of cytoreduction in stage III and IV uterine papillary serous carcinoma.

OBJECTIVE

Uterine papillary serous carcinoma (UPSC) frequently presents in advanced stages. The aim of this study was to assess the role of cytoreduction in stage IIIC-IV UPSC.

METHODS

Retrospective review was conducted of UPSC from 1982 through 2005. Surgical treatment consisted of hysterectomy, removal of adnexae, and pelvic and paraaortic lymphadenectomy, with or without tumor cytoreduction. Median follow-up was 21 months.

RESULTS

Of the 125 UPSC patients, analysis of stage IIIC-IV patients (n=70; stage IIIC 12, stage IV 58) was performed. Optimal cytoreduction was achieved in 42 of 70 (60%) patients, and optimal cytoreduction with no visible residual disease in 26 of 70 (37%) patients. Patients with no visible residual disease after cytoreduction had a better median survival (51 months) compared to optimally cytoreduced albeit with residual disease (14 months), and suboptimally cytoreduced patients (12 months) (p-value=0.002). Of the 45 patients who received CT, the median survival of patients with no residual disease vs. patients with residual disease was 52 months vs. 16 months (p<0.001) respectively. No reduction in survival was noted when radical procedures were necessary to completely remove all residual disease. Regression analysis identified absence of visible residual disease (hazard ratio (HR)=0.30, p<0.001) and CT (HR=0.56, p=0.07) as independent predictors of OS.

DISCUSSION

Cytoreduction to no gross residual disease and the use of CT are associated with a significant survival benefit for patients with stage IIIC-IV UPSC. This effect persisted even in patients who underwent radical resections.