Clinical (stage III) as compared to subclinical intrapelvic extrauterine tumor spread in endometrial carcinoma: a clinical and histopathological study of 175 patients.

One hundred and seventy-five patients with endometrial cancer, seen in the Norwegian Radium Hospital from 1960 to 1977, had tumor extension outside the uterus but not outside the true pelvis. One hundred and eight of these patients had clinical stage III disease and in 67 patients, originally classified as stage I or stage II, the intrapelvic extrauterine tumor spread was first detected at surgery or at histopathological examination of the operation specimen. The 40% 5-year-actuarial survival of the latter group differed significantly from the 16% found in clinical stage III (P less than 0.001). This must be largely contributed to the fact that radical surgery could only be performed in 13% of the clinical stage III group as compared to 70% in the group of patients with subclinical extrauterine disease. Surgical eradication of all macroscopic tumor was of major prognostic importance for patients with clinical stage III, resulting in an actuarial 5-year survival of 41%, nearly identical to 42% for the group of patients with subclinical extrauterine tumor extension. Adjuvant progestagen therapy seemed to be of some benefit, but the need, however, for a more effective systemic treatment, possibly using cytotoxic drugs, is evident.