Transection of vaginal cuff is an independent prognostic factor in stage I endometrial cancer

Aims

The objective was to identify prognostic factors of disease-free and overall survival in stage I endometrial carcinoma, thereby potentially facilitating the selection of patients who are on high risk for recurrence and who may benefit from transection of a vaginal cuff.

Methods

In a retrospective review between 1994 and 2004, 340 patients with stage I endometrial carcinoma were managed surgically at two different hospitals in Rostock. The median follow-up was 79 (range 12–161) months. Clinical and histological parameters were compared using the SPSS software package.

Results

In the univariate analysis the factors associated with poor disease-free survival in stage I carcinoma were higher tumor grade (P = 0.013), and no removed vaginal cuff (P = 0.025). The corresponding factor for impaired overall survival was no removed vaginal cuff (P = 0.003). All parameters with a P-value < 0.25 in the univariate setting were entered into a multivariate analysis. The factors that maintained associated with poor disease-free and overall survival were higher tumor grade and lack of vaginal cuff.

Conclusions

The removal of a vaginal cuff during abdominal hysterectomy was found to be an independent prognostic factor in stage I endometrial carcinomas. A prospective surgical trial is needed to validate our results before changing current clinical practice.