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Stage IIIA Endometrial Carcinoma: Outcome and Predictors of Survival

OBJECTIVE: To examine predictors of survival for stage IIIA endometrial cancer and to compare the outcome of stage IIIA neoplasms to that of endometrial tumors confined to the uterus. METHODS: Women with stage IIIA endometrioid adenocarcinomas of the uterus treated between 1998 and 2004 were examined. Patients were stratified into two groups: positive cytology only (IIIA1) or ovarian or pelvic metastases (IIIA2). The clinical characteristics and outcome of stage IIIA1 and IIIA2 patients were compared. To further examine patients with positive cytology alone, women with IIIA1 tumors were compared with women with stage IB and IC tumors. Survival was examined using Cox proportional hazards models and the Kaplan-Meier method. RESULTS: A total of 1,257 women, including 485 (39%) with IIIA1 and 772 (61%) with IIIA2 lesions, were identified. In a proportional hazards model incorporating known prognostic variables, there was no difference in survival (hazard ratio 1.06, 95% confidence interval [CI] 0.85–1.32) between IIIA1 and IIIA2 tumors. Five-year survival was 67% (95% CI 61–72%) for IIIA1 and 55% (95% CI 53–58%) for IIIA2 cancers. The results were unchanged when only women who underwent staging lymphadenectomy were included. Mortality was higher for IIIA1 tumors than stage IB and IC cancers. At 5 years, 90% (95% CI 89–90%) of patients with IB and 77% (95% CI 75–79%) with stage IC tumors were alive compared with 67% (95% CI 61–72%) of women with IIIA1 neoplasms. CONCLUSION: Patients with stage IIIA1 tumors seem to have an outcome that is similar to that of women with serosal or adnexal metastases. The outcome of stage IIIA1 endometrial cancer is inferior to that of tumors confined to the corpus (stage IB and IC). LEVEL OF EVIDENCE: II