Role of cytoreduction in stage III and IV uterine papillary serous carcinoma

Objective: Uterine papillary serous carcinoma (UPSC) frequently presents in advanced stages. The aim of this study was to assess the role of cytoreduction in stage IIIC-IV UPSC. Methods: Retrospective review was conducted of UPSC from 1982 through 2005. Surgical treatment consisted of hysterectomy, removal of adnexae, and pelvic and paraaortic lymphadenectomy, with or without tumor cytoreduction. Median follow-up was 21 months. Results: Of the 125 UPSC patients, analysis of stage IIIC-IV patients (n = 70; stage IIIC 12, stage IV 58) was performed. Optimal cytoreduction was achieved in 42 of 70 (60%) patients, and optimal cytoreduction with no visible residual disease in 26 of 70 (37%) patients. Patients with no visible residual disease after cytoreduction had a better median survival (51 months) compared to optimally cytoreduced albeit with residual disease (14 months), and suboptimally cytoreduced patients (12 months) (p-value = 0.002). Of the 45 patients who received CT, the median survival of patients with no residual disease vs. patients with residual disease was 52 months vs. 16 months (p < 0.001) respectively. No reduction in survival was noted when radical procedures were necessary to completely remove all residual disease. Regression analysis identified absence of visible residual disease (hazard ratio (HR) = 0.30, p < 0.001) and CT (HR = 0.56, p = 0.07) as independent predictors of OS. Discussion: Cytoreduction to no gross residual disease and the use of CT are associated with a significant survival benefit for patients with stage IIIC-IV UPSC. This effect persisted even in patients who underwent radical resections.