The Demographics and Outcomes of Women With Stage II Endometrial Cancer Diagnosed in Australia 2005-2007.

Abstract

Background: Stage II endometrial cancer comprises 5% to 10% of cases and is pathologically diverse. Retrospective data guides recommendations which suggest surgical staging with adjuvant therapy, but the role of radical surgery and lymphadenectomy is uncertain, due to conflicting outcomes. Treatment decisions are influenced by histopathology, yet a definitive standard of care is still elusive.

Objectives: To identify prognostic factors affecting stage II endometrial cancer survival and assess the 2009 FIGO staging changes using data from the Australian National Endometrial Cancer Study (ANECS).

Materials and methods: Ninety patients were identified between July 2005 and December 2007. Survival data was analysed using Kaplan-Meier estimates and Cox regression models, with ethics approval from QIMR.

Results: Ninety patients were identified with an average age of 60 and mean body mass index (BMI) of 30. Positive cytology (HR 5.4 [CI: 1.32-22.15]) and chemotherapy alone (HR 17.3) [CI: 2.65-112.6] were identified overall survival (OS) predictors in univariate and age (HR 1.81; [CI: 1.13-2.91]) in multivariate analyses. LVSI was a significant progression free survival (PFS) predictor (HR 4.29; [CI: 1.13-16.26]). There was no significant difference in OS (p = 0.9) and PFS (p = 0.6) when cases were re-stratified into the 1988 stage IIA and IIB groups.

Conclusions: The study supports contemporary management of simple hysterectomy with lymph node assessment and the refined 2009 stage II definition. Current treatment paradigms could also be refined based upon prognostic factors like age and LVSI.