Assessment of the impact of treatment process on clinical outcomes in uterine papillary serous carcinoma

Endometrial cancer is the sixth most common cancer among women worldwide. Serous endometrial cancer ranks second in frequency after the endometrioid histological subtype and accounts for 10% of all endometrial cancer cases. The most important feature is that the serous subtype is responsible for 40% of endometrial cancer related deaths. Our study aims to define changes in clinical outcomes of patients with serous endometrial cancer who have been under our care; based on their stages, surgical characteristics, pathological features and treatment strategies. We conducted a retrospective examination of 118 patients with endometrial serous carcinoma who were treated at Hacettepe University Gynecological Oncology Clinic between June 2001 and November 2022. The mean age of our group was 66,1 years (8,24). All patients underwent surgical management, with 78% receiving complete surgical staging. The median follow-up period was 30 months (1,6-219). The 5-year overall survival was 45,5%. Our study demonstrated that lymphadenectomy (p = 0.04), especially in advanced stages (stage III or IV), significantly contributed to overall survival, while routine omentectomy did not provide any additional benefit. According to multivariate Cox analyses, age ≥60 years (HR=3.52 [95% CI: 1.17–10.57], p=0.25), high serum CA 125 levels (HR=2.07 [95% CI: 1–4.3], p=0.04), and having stage III or IV disease according to FIGO 2023 (HR=1.18 [95% CI: 1.06–1.31], p=0.002) were identified as independent prognostic factors for overall survival. When comparing the new FIGO 2023 staging system with the old one it was noted that patients with serous endometrium cancer at stage I increased to stage II. It is worth mentioning that lymphovascular space invasion and cervical involvement, which significantly affect survival, are not utilized in determining the stage of patients with serous endometrial cancer in the new staging system. However, in the ROC analysis, we observed that the performances of both stagings were similar. Keywords: Serous endometrial cancer, survival, surgical staging