Ovarian preservation and staging in reproductive-age endometrial cancer patients

ObjectivesThe goal of this case review was to evaluate the influence of complete surgical versus clinical staging, including the impact of ovarian preservation, on the outcome of young patients with endometrial carcinoma.MethodsA retrospective chart review was performed on all patients with endometrial cancer diagnosed at age 45 or younger from 1960 until 2006 who were treated at Yale-New Haven Hospital (YNHH). Clinical, epidemiological and histological data were extracted. Histological slides were reviewed by the gynecologic pathologist. Statistical analysis was performed, and p < 0.05 was considered statistically significant.ResultsMore than half of the patients underwent surgical staging. A bilateral salpingo-oophorectomy (BSO) was part of the surgery in most cases. Less than 5% of patients were diagnosed with recurrence. In patients with grade 1 disease, surgically staged patients had a significantly longer overall survival (p = 0.003). Patients who underwent a BSO had a trend towards longer disease-free survival. Stage I disease patients who underwent BSO had significantly longer disease-free survival (p = 0.013).ConclusionsBSO seems to lead to better disease-free survival in young endometrial cancer patients, especially with stage I disease, but not to improved overall survival. In the absence of risk factors, a more conservative approach to surgical staging may be possible in young women with early stage low grade endometrial cancer but BSO should be strongly considered as part of the surgical treatment.