Stage IVB endometrial carcinoma: The role of cytoreductive surgery and determinants of survival

Objective. The aim of this study was to evaluate the role of cytoreductive surgery and survival determinants in patients with Stage IVB endometrial carcinoma. Methods. All patients with Stage IVB endometrial carcinoma diagnosed between 1/1/90 and 12/31/98 were identified from tumor registry databases. Individual patient data were collected retrospectively. Survival analyses and comparisons were performed using the Kaplan-Meier method and the log-rank test. The Cox proportional hazards model was used to identify independent variables associated with survival. Results. Sixty-five patients underwent surgery as primary therapy for Stage IVB endometrial carcinoma (median survival 14.8 months). The median age of the population was 65 years (range 29-85 years); 89.2% of patients were postmenopausal, and 21.5% were nulliparous. The most common histologic subtypes were endometrioid (33.8%), serous (32.3%), and mixed (16.9%). Optimal cytoreductive surgery (residual tumor less than or equal to 1 cm in maximal diameter) was accomplished in 36 patients (55.4%), while 29 patients (44.6%) were left with >1 cm residual disease. The median survival rate of patients undergoing optimal surgery was 34.3 months, a statistically significant advantage compared to patients with >1 cm residual tumor (11.0 months, P = 0.0001). Among those with optimal surgery, patients with only microscopic residual disease survived significantly longer than patients with optimal but macroscopic residual tumor. Higher performance status, age less than or equal to 58 years, and adjuvant chemotherapy followed by radiation therapy were also significantly associated with superior survival on univariate analysis. On multivariate analysis, residual disease (P = 0.0001), performance status (P = 0.043), and age (P = 0.023) were independent predictors of survival. Conclusions. The amount of residual disease after cytoreductive surgery, age, and performance status appear to be important determinants of survival in patients with Stage IVB endometrial carcinoma. Maximal cytoreduction should be the goal at the time of primary surgery for advanced disease. For selected patients, combined postoperative chemotherapy and radiation therapy may provide some therapeutic benefit. (C) 2000 Academic Press.