An analysis of current treatment practice in uterine papillary serous and clear cell carcinoma at two high volume cancer centers

• Published in: Journal of gynecologic oncology 2015, 26(1), , pp.25-31
• Main Authors: Vogel, Tilley Jenkins, Knickerbocker, Abhay, Shah, Chirag A, Schiff, Melissa A, Isacson, Christina, Garcia, Rochelle L, Goff, Barbara A
• Format: Article
• Language: English
• Subjects: Adenocarcinoma, Clear Cell - pathology; Adenocarcinoma, Clear Cell - secondary; Adenocarcinoma, Clear Cell - therapy; Aged; Chemotherapy, Adjuvant; Cystadenocarcinoma, Papillary - pathology; Cystadenocarcinoma, Papillary - secondary; Cystadenocarcinoma, Papillary - therapy; Cystadenocarcinoma, Serous - pathology; Cystadenocarcinoma, Serous - secondary; Cystadenocarcinoma, Serous - therapy; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Original; Professional Practice; Radiotherapy, Adjuvant; Retrospective Studies; Robotic Surgical Procedures; Survival Analysis; Treatment Outcome; Uterine Neoplasms - pathology; Uterine Neoplasms - therapy; 산부인과학
• ISSN: 2005-0380; 2005-0399
• DOI: 10.3802/jgo.2015.26.1.25

Despite the rarity of uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCCC), they contribute disproportionately to endometrial cancer deaths. Sufficient clinical information regarding treatment and prognosis is lacking. The aim of this study is to evaluate treatment outcomes in a rare cancer cohort based on the experience at two tertiary care cancer centers. Clinicopathologic data were retrospectively collected on 279 patients with UPSC and UCCC treated between 1995 to 2011. Mode of surgery, use of adjuvant treatment, and dissection of paraaoritc lymph nodes were evaluated for their association with overall survival (OS) and progression-free survival (PFS). 40.9% of patients presented with stage I disease, 6.8% of patients presented with stage II disease and 52.3% of patients presented with stages III and IV. Median follow-up was 31 months (range, 1 to 194 months). OS and PFS at 5 years were 63.0% and 51.9%, respectively. OS and PFS were not affected by mode of surgery (open vs. robotic approach; OS: hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.28 to 1.62; PFS: HR, 0.78; 95% CI, 0.40 to 1.56). Adjuvant treatment was associated with improved OS in stages IB-II (HR, 0.14; 95% CI, 0.02 to 0.78; p=0.026) but not in stage IA disease. There was no difference in OS or PFS based on the performance of a paraaoritc lymph node dissection. Minimally invasive surgical staging appears a reasonable strategy for patients with non-bulky UPSC and UCCC and was not associated with diminished survival. Adjuvant treatment improved 5-year survival in stages IB-II disease.