Annals of Surgical Oncology

, Volume 18, Issue 5, pp 1419–1424 | Cite as

Lower Uterine Segment Involvement is Associated with Poor Outcomes in Early-Stage Endometrioid Endometrial Carcinoma

  • Nora T. KizerEmail author
  • Feng Gao
  • Saketh Guntupalli
  • Premal H. Thaker
  • Matthew A. Powell
  • Paul J. Goodfellow
  • David G. Mutch
  • Israel Zighelboim
Gynecologic Oncology



The clinicopathologic significance of lower uterine segment involvement (LUSI) in endometrial cancer patients remains unclear. Although LUSI has been reported to be a prognostic indicator, literature is limited.


We studied 481 surgically staged endometrioid endometrial cancers with disease confined to the uterus (FIGO 1988 stage I or II). Primary outcomes were overall survival (OS) and disease-free survival (DFS). The relationships between LUSI and OS and DFS were assessed using the Kaplan–Meier method and Cox proportional hazard models. The t test or Fisher exact test was used for evaluating relationships between variables of interest.


LUSI was present in 223 cases (46.4%), and was associated with both decreased disease free survival (P = 0.02) and overall survival (P = 0.01) in univariate analysis. Multivariate analysis confirmed the association between LUSI and increased risk for recurrence [hazard ratio (HR) 2.27; 95% confidence interval (95% CI) 1.09–4.7; P = 0.03] and increased mortality (HR 1.76; 95% CI 1.12–2.78; P = 0.01).


LUSI in patients with early-stage endometrioid endometrial cancer is associated with decreased survival.


Overall Survival Endometrial Cancer Lynch Syndrome Endometrial Carcinoma Figo Stage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors wish to acknowledge the support of the Biostatistics Core, Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842. Supported by RO1 CA71754 (P.J.G.), Barnes-Jewish Foundation 00161-0806 (P.J.G.) and 1T32HD055172-01A2 (N.T.K.)


Kizer et al. have nothing to disclose.


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Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Nora T. Kizer
    • 1
    Email author
  • Feng Gao
    • 2
  • Saketh Guntupalli
    • 1
  • Premal H. Thaker
    • 1
  • Matthew A. Powell
    • 1
  • Paul J. Goodfellow
    • 1
    • 3
  • David G. Mutch
    • 1
  • Israel Zighelboim
    • 1
  1. 1.Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Siteman Cancer CenterWashington University School of MedicineSaint LouisUSA
  2. 2.Division of Biostatistics, Siteman Cancer CenterWashington University School of MedicineSaint LouisUSA
  3. 3.Division of Endocrine and Oncologic Surgery, Department of Surgery, Siteman Cancer CenterWashington University School of MedicineSaint LouisUSA

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