Impact of tubal ligation on routes of dissemination and overall survival in uterine serous carcinoma

Tina A. Ayeni, Jamie N. Bakkum-Gamez, Andrea Mariani, Michaela E. McGree, Amy L. Weaver, Mariam M. Alhilli, Janice R. Martin, Gary L. Keeney, Sean C. Dowdy, Karl C. Podratz

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objective: Abdominal peritoneal implants are characteristic of uterine serous carcinoma (USC). The presumed mechanism of dissemination is retrograde transit via the fallopian tube. We assessed the impact of tubal ligation (TL) on the metastatic profile and survival of USC patients. Methods: Patient risk factors, process-of-care variables, and disease-specific parameters were annotated. Categorical variables were compared using the χ2 test. Overall survival (OS) was estimated via the Kaplan-Meier method. Results: Among 211 USC patients, fallopian tube status was documented in 142 patients; 35 had a history of TL and 107 did not. When comparing patients with and without TL, positive peritoneal cytology was present, respectively, in 18.8% vs 45.0% (P =.01) and stage IV disease in 14.3% vs 34.6% (P =.02). Using Cox models, age was the sole significant determinant of OS in stage I/II USC. By contrast, age, lymphovascular space involvement, positive cytology, and TL independently and adversely affected survival in stage III/IV USC. Adjusting for these factors in a multivariable model, the association between TL and OS among patients with advanced disease yielded a hazard ratio of 8.61 (95% CI, 3.08-24.03; P <.001). The prevalence of lymphatic metastasis and nodal tumor burden was significantly greater in patients who underwent ligation. Conclusion: Patients with TL had significantly lower rates of positive cytology and stage IV disease than patients without TL. The lymphatic system appeared to be the dominant mode of spread after TL and was associated with a paradoxic worsening of OS, perhaps reflecting a delay in diagnosis.

Original languageEnglish (US)
Pages (from-to)71-76
Number of pages6
JournalGynecologic oncology
Issue number1
StatePublished - Jan 2013


  • Clinical management
  • Serous endometrial cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology


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