Endometrial carcinoma with extra-abdominal metastasis: improved prognosis following cytoreductive surgery

Ann Surg Oncol. 2010 Apr;17(4):1111-7. doi: 10.1245/s10434-009-0892-8.


Background: Incidence of endometrial carcinoma, the most common malignancy of the female pelvis, has been steadily increasing during the last three decades. The prognosis for stage IVb cases with extra-abdominal metastases is extremely poor, with no current consensus regarding treatment. The aim of the present study was to examine the benefits of cytoreductive surgery for such cases.

Methods: Clinicopathological features of 33 stage IVb cases of endometrial carcinoma diagnosed during the 1991-2008 study period were retrospectively reviewed utilizing clinical records. Cytoreduction was conducted in 30 cases.

Results: The median progression-free survival (PFS) and overall survival (OS) of those patients with optimal cytoreduction of their disease (with residual masses < or =2 cm), were significantly better than those with suboptimal reduction (with residual masses > 2 cm), not only among the 15 stage IVb patients with only intra-abdominal metastasis (group I) (P = 0.0003 and 0.0007) but also among the 15 cases with extra-abdominal metastasis (group E) (P = 0.013 and 0.016). Multivariate Cox proportional-hazards analysis demonstrated that the adjusted hazard ratio (HR) for the maximum size of residual disease (>2 vs. < or =2 cm) was 10.4 [95% confidence interval (CI), 1.27-84.70, P = 0.030] in group I and 16.92 (95% CI, 1.41-203.09, P = 0.026) in group E.

Conclusions: This is the first demonstration that aggressive cytoreductive surgery for stage IVb endometrial carcinoma with extra-abdominal metastasis has a beneficial role. However, further investigation is still required to establish better standard therapy for stage IVb endometrial cancer.

MeSH terms

  • Adenocarcinoma, Clear Cell / mortality
  • Adenocarcinoma, Clear Cell / secondary
  • Adenocarcinoma, Clear Cell / surgery*
  • Aged
  • Cystadenocarcinoma, Serous / mortality
  • Cystadenocarcinoma, Serous / secondary
  • Cystadenocarcinoma, Serous / surgery*
  • Endometrial Neoplasms / mortality
  • Endometrial Neoplasms / pathology
  • Endometrial Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Lymph Node Excision
  • Lymph Nodes / pathology
  • Middle Aged
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome