Uterine papillary serous carcinoma (UPSC): a single institution review of 129 cases

Abstract

Objective: The aim of this study was to identify clinical and pathologic characteristics of patients with uterine papillary serous carcinoma (UPSC) who were all surgically managed at a single institution. The identified characteristics were then correlated with overall survival (OS).

Methods: One hundred twenty-nine patients with FIGO stage I-IV UPSC who were surgically staged at the University of Texas M. D. Anderson Cancer Center between 1989 and 2002 were identified. For each patient, medical records and pathology reports were reviewed. The Kaplan-Meier method was used to generate OS data. Factors predictive of outcome were compared using the log-rank test and Cox regression analysis.

Results: There were 52 patients with stage I disease, 5 with stage II, 41 with stage III, and 31 with stage IV. The median age at the time of diagnosis was 68 years (range, 44-93 years). A personal history of breast cancer was reported by 12.4% of the patients, and a family history of breast cancer was reported by 16%. The 5-year OS among all patients was 45.9%. Among the stage I patients (IA, n = 19; IB, n = 26; and IC, n = 7), the 5-year OS was 62.9% (IA, 81.5%; IB, 58.6%; and IC, 34.3%). The 5-year OS for patients with stage III and IV disease was 37.3 and 19.9%, respectively. Pathologic features predictive of OS included lymph node status (P </= 0.01), lymph vascular invasion (P </= 0.05), and depth of uterine invasion (P </= 0.05). Among patients with no uterine invasion (n = 32), surgical staging revealed that 37% had stage III or IV disease. Among stage III patients, those who received chemotherapy had a longer OS than those who did not receive chemotherapy (P = 0.03).

Conclusion: In this population of nonselected patients with UPSC, approximately 20% had a personal or family history of breast cancer. Stage, lymph node status, lymph vascular invasion, and depth of myometrial invasion were all risk factors for a worse prognosis. Traditional risk factors, however, did not predict the presence or the absence of metastasis. Among patients with noninvasive uterine disease, there was a high proportion with abdominal metastasis. Therefore, complete surgical staging of these patients is vital in determining their prognosis.