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.

Increasing detection rate of benign renal tumors: evaluation of factors predicting for benign tumor histologic features during past two decades.

OBJECTIVES: To determine whether the detection of benign renal tumors is increasing and to identity the predictors of benign histologic features. The detection of renal cortical tumors has increased with the increased use of abdominal imaging. Current imaging and biopsy techniques cannot predict the renal tumor histologic features with complete accuracy, and many patients undergo surgery for benign lesions. METHODS: The Columbia Urologic Oncology Database was reviewed, and 1244 patients who had undergone partial or radical nephrectomy from 1988 to 2007 were identified. A cohort of 775 patients with a tumor diameter of .05). CONCLUSIONS: Even when controlling for tumor diameter and sex, the incidence of benign tumors detected at renal surgery at our institution has increased significantly in the past 2 decades.

Safety of ovarian preservation in premenopausal women with endometrial cancer.

PURPOSE: Oophorectomy is commonly performed in premenopausal women with endometrial cancer who undergo hysterectomy. The benefits of oophorectomy in this setting are unknown, and the procedure subjects women to the long-term sequelae of estrogen deprivation. We examined the safety of ovarian preservation in young women with endometrial cancer who underwent hysterectomy. PATIENTS AND METHODS: Women < or = 45 years of age with stage I endometrial cancer recorded from 1988 to 2004 in the Surveillance, Epidemiology, and End Results Database were examined. We developed Cox proportional hazards models and Kaplan-Meier curves to compare women who underwent oophorectomy with those who had ovarian preservation. RESULTS: A total of 3,269 women, including 402 patients (12%) who had ovarian preservation, were identified. Younger age (P < .0001), later year of diagnosis (P = .04), residence in the eastern United States (P = .02), and low tumor grade (P < .0001) were associated with ovarian preservation. In a multivariate Cox model, ovarian preservation had no effect on either cancer-specific (hazard ratio [HR] = 0.58; 95% CI, 0.14 to 2.44) or overall (HR = 0.68; 95% CI, 0.34 to 1.35) survival. The findings were unchanged when women who received pelvic radiotherapy were excluded. CONCLUSION: Ovarian preservation in premenopausal women with early-stage endometrial cancer may be safe and not associated with an increase in cancer-related mortality.