Background:

Stage IV uterine papillary serous carcinoma (UPSC) is rare and usually mimic advanced ovarian cancer in its presentation and disease distribution. The standard for treatment is primary cytoreductive surgery (PCS) followed by adjuvant chemotherapy. The use of neoadjuvant chemotherapy (NAC) has gained more popularity in recent years based on evidence extrapolated from ovarian cancer research and from small retrospective studies.

Objectives:  

The primary objective was to analyze the clinicopathological factors and to determine the progression-free survival (PFS) and overall survival (OS) in patients with stage IV UPSC treated at Queensland Centre for Gynaecological cancer (QCGC). A secondary objective was to compare the survival outcomes of women with stage IV UPSC treated with NAC and interval cytoreduction with women treated with primary cytoreductive surgery PCS followed by adjuvant chemotherapy

Material and Methods:

The study is a retrospective cohort review. We used the database of QCGC to review medical and pathological records. Women diagnosed with Stage IV UPSC at QCGC between January 2005 and December 2014 were reviewed. Demographics and surgical outcomes were analysed. PFS and OS were estimated by using Kaplan-Meier methods. A sub analysis was made to compare the outcomes of women with Stage IV UPSC who were treated with NAC and women who were treated with PCS. Comparison between study groups was tested by log-rank statistics

Results:

We identified and reviewed 50 with stage IV UPSC who were treated at QCGC between Jan 2005 and Dec 2014. 37 patients underwent primary cytoreductive surgery. Nine patients received neoadjuvant chemotherapy, Eight underwent interval debulking, and one did not due to progressive disease. Four patients received no active treatment and were referred to palliative care. Patients who underwent NAC when compared to patients who underwent PCS were older ( 72.1 Vs 71 ), more likely to have multiple medical co-morbidites ( > 3) ( 77.8 % Vs 48.6 % ), had a higher chance of optimal debulking surgery (77.8% Vs 67.6 %) and Lower complication rates (11.1 Vs 16.2%). The PFS for patients who underwent NAC was lower than patients who underwent PCS (Median of 9.5 months Vs 12.2 months) and the OS was lower (Median of 20.0 months Vs 24.5 months) 

Conclusion:

In our series, patients with stage IV UPSC had poor prognosis.  Neodjuvant chemotherapy compared to primary cytoreductive surgery was associated with less favourable outcome which might reflect the surgeon’s preference to offer NAC to more sick patients with more advanced disease.