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Prospective evaluation of prognostic significance of the tumor-free distance from uterine serosa in surgically staged endometrial adenocarcinoma.

Abstract

OBJECTIVE

To determine if tumor-free distance (TFD) from the uterine serosa predicts surgicopathologic factors and outcome in surgically staged endometrial cancer, and to compare TFD with the traditional estimate of depth of myometrial invasion (DOI).

METHODS

Patients who underwent complete surgical staging for primary endometrial cancer at a single institution were identified from 2002-2005. During this time, TFD was prospectively measured at the time of pathologic evaluation of the uterine specimen. Tumor-free distance (TFD) was defined as distance from deepest myometrial invasion to the serosal surface, whereas DOI was defined as the distance between the endomyometrial junction and deepest myometrial invasion. DOI and TFD were shown as continuous variables and compared to traditional surgicopathologic factors and evaluated for their ability to predict recurrence and death from disease. Univariate and multivariate analysis were used to examine the data. Receiver-operator characteristic curve was created to evaluate optimal TFD.

RESULTS

We identified 99 patients that met the study criteria. Mean DOI was 0.6 cm and mean TFD was 1.3 cm. 77 patients were stage I, 11 were stage II, and 11 were stage III. Tumor grade was distributed as 68, 21 and 10 for grades 1, 2, and 3 respectively. Median follow up time was 2.7 years (1002 days) with 9 episodes of recurrence and 7 deaths. Univariate analysis demonstrated DOI to be a significant predictor of death, grade, lymph node metastasis, lymphovascular space involvement (LVSI), stage, lower uterine segment (LUS) involvement and adnexal involvement. TFD significantly predicted lymph node metastasis, LVSI, and grade. Using Cox proportional hazards model, DOI more significantly predicted recurrence (hazard ratio 3.11, p=0.0007). Both DOI and TFD predicted death from disease (hazard ratio 3.58, p=0.0006 and 0.22, p=0.0365, respectively). Although the performance characteristics of TFD were modest, the balance of sensitivity and specificity for TFD in predicting recurrence was 1 cm.

CONCLUSIONS

TFD, like DOI, is predictive of many surgicopathological variables and patient outcome in surgically staged endometrial cancer. Although the performance characteristics may not be as powerful as DOI, the ease and reproducibility of this measurement may justify its inclusion in synoptic reporting of endometrial cancer.

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  • Authors+Show Affiliations

    ,

    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, Ohio 43210, USA.

    , , ,

    Source

    Gynecologic oncology 112:1 2009 Jan pg 146-9

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Carcinoma, Endometrioid
    Endometrial Neoplasms
    Female
    Humans
    Middle Aged
    Myometrium
    Neoplasm Invasiveness
    Neoplasm Staging
    Prognosis
    Prospective Studies
    ROC Curve

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    18937970

    Citation

    Schwab, Katherine V., et al. "Prospective Evaluation of Prognostic Significance of the Tumor-free Distance From Uterine Serosa in Surgically Staged Endometrial Adenocarcinoma." Gynecologic Oncology, vol. 112, no. 1, 2009, pp. 146-9.
    Schwab KV, O'Malley DM, Fowler JM, et al. Prospective evaluation of prognostic significance of the tumor-free distance from uterine serosa in surgically staged endometrial adenocarcinoma. Gynecol Oncol. 2009;112(1):146-9.
    Schwab, K. V., O'Malley, D. M., Fowler, J. M., Copeland, L. J., & Cohn, D. E. (2009). Prospective evaluation of prognostic significance of the tumor-free distance from uterine serosa in surgically staged endometrial adenocarcinoma. Gynecologic Oncology, 112(1), pp. 146-9. doi:10.1016/j.ygyno.2008.09.009.
    Schwab KV, et al. Prospective Evaluation of Prognostic Significance of the Tumor-free Distance From Uterine Serosa in Surgically Staged Endometrial Adenocarcinoma. Gynecol Oncol. 2009;112(1):146-9. PubMed PMID: 18937970.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prospective evaluation of prognostic significance of the tumor-free distance from uterine serosa in surgically staged endometrial adenocarcinoma. AU - Schwab,Katherine V, AU - O'Malley,David M, AU - Fowler,Jeffrey M, AU - Copeland,Larry J, AU - Cohn,David E, Y1 - 2008/10/19/ PY - 2008/07/30/received PY - 2008/08/27/revised PY - 2008/09/03/accepted PY - 2008/10/22/pubmed PY - 2009/1/3/medline PY - 2008/10/22/entrez SP - 146 EP - 9 JF - Gynecologic oncology JO - Gynecol. Oncol. VL - 112 IS - 1 N2 - OBJECTIVE: To determine if tumor-free distance (TFD) from the uterine serosa predicts surgicopathologic factors and outcome in surgically staged endometrial cancer, and to compare TFD with the traditional estimate of depth of myometrial invasion (DOI). METHODS: Patients who underwent complete surgical staging for primary endometrial cancer at a single institution were identified from 2002-2005. During this time, TFD was prospectively measured at the time of pathologic evaluation of the uterine specimen. Tumor-free distance (TFD) was defined as distance from deepest myometrial invasion to the serosal surface, whereas DOI was defined as the distance between the endomyometrial junction and deepest myometrial invasion. DOI and TFD were shown as continuous variables and compared to traditional surgicopathologic factors and evaluated for their ability to predict recurrence and death from disease. Univariate and multivariate analysis were used to examine the data. Receiver-operator characteristic curve was created to evaluate optimal TFD. RESULTS: We identified 99 patients that met the study criteria. Mean DOI was 0.6 cm and mean TFD was 1.3 cm. 77 patients were stage I, 11 were stage II, and 11 were stage III. Tumor grade was distributed as 68, 21 and 10 for grades 1, 2, and 3 respectively. Median follow up time was 2.7 years (1002 days) with 9 episodes of recurrence and 7 deaths. Univariate analysis demonstrated DOI to be a significant predictor of death, grade, lymph node metastasis, lymphovascular space involvement (LVSI), stage, lower uterine segment (LUS) involvement and adnexal involvement. TFD significantly predicted lymph node metastasis, LVSI, and grade. Using Cox proportional hazards model, DOI more significantly predicted recurrence (hazard ratio 3.11, p=0.0007). Both DOI and TFD predicted death from disease (hazard ratio 3.58, p=0.0006 and 0.22, p=0.0365, respectively). Although the performance characteristics of TFD were modest, the balance of sensitivity and specificity for TFD in predicting recurrence was 1 cm. CONCLUSIONS: TFD, like DOI, is predictive of many surgicopathological variables and patient outcome in surgically staged endometrial cancer. Although the performance characteristics may not be as powerful as DOI, the ease and reproducibility of this measurement may justify its inclusion in synoptic reporting of endometrial cancer. SN - 1095-6859 UR - https://www.unboundmedicine.com/medline/citation/18937970/Prospective_evaluation_of_prognostic_significance_of_the_tumor_free_distance_from_uterine_serosa_in_surgically_staged_endometrial_adenocarcinoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-8258(08)00724-5 DB - PRIME DP - Unbound Medicine ER -