Lower uterine segment involvement is associated with adverse outcome in patients with stage I endometroid endometrial cancer: Results of a multicenter study

Objective: To quantify the relative risk associated with lower Uterine segment involvement (LUSI) on outcomes measures in patients with apparent stage I endometroid endometrial cancer. Methods: A cohort of 769 Consecutive patients with endometroid endometrial carcinoma apparent stage L Who underwent surgery ill live gynecological oncology center, in Israel 138 patients with and 631 without LUSI were followed for a median time of 5 1 months. Local recurrence. recurrence-free and overall survival were compared between file two groups. Results: LUSI was associated with grade 3 tumor (p < 0.002), deep myometrial invasion (p < 0.001). and the presence of lymphvascular space involvement (p = 0.01). There were 22 cases of local recurrences, 40 cases of distal recurrences and 80 patients died. Univariate Survival analysis showed that patients with LUSI had trend toward lower regional recurrence-free survival (p = 0.09) and significant lower distant recurrence-free survival (p = 0.04) and lower overall survival (p = 0.002). The Cox proportional hazards model demonstrated a significantly decreased overall survival (HR = 2.3; 95% CI 1.3, 3.9; p = 0.003) in cases with LUSI Conclusions: In patients with apparent stage I endometroid endometrial cancer. the presence of LUSI is a pool-prognostic factor. associated with a significantly higher risk of distal recurrence and death. The presence of LUSI warrants consideration when deciding upon surgical staging or postoperative management. (C) 2008 Elsevier Ltd. All rights reserved.