Survival after pelvic exenteration for uterine malignancy: A National Cancer Data Base study

Objective To determine overall survival (OS) and factors associated with OS after pelvic exenteration for uterine cancer. Methods Women with uterine cancer who underwent exenteration (n = 1160) were identified from the 1998–2011 National Cancer Data Base. Kaplan-Meier and multivariate Cox proportional-hazards survival analyses were performed to test for associations of potential explanatory variables with OS. Analyzed confounders included age, comorbidity score, insurance status, income, distance from home to treatment center, stage, distant and nodal metastasis, tumor size, surgical margin status, exenteration type, and treatment with radiation and/or chemotherapy. Results Among women with follow-up data (n = 652), median (IQR) OS was 63.1 (42.2–107.2) and 17.6 (14.7–23.9) months for women with node-negative versus node-positive disease, respectively. Histology (p = 1.5 × 10^− 4), grade (p = 7.9 × 10^− 14), race (p = 0.0002), lymph node status (p = 1.0 × 10^− 14), surgical node evaluation (p = 2.8 × 10^− 8), surgery for distant metastasis (p = 0.004), distant metastasis at diagnosis (p = 1.3 × 10^− 10), positive surgical margins (p = 1.6 × 10^− 9), radiotherapy (p = 0.004), and insurance status (p = 6.5 × 10^− 6) were significantly associated with differential, unadjusted Kaplan-Meier OS estimates. Exenteration type was not associated with OS (p = 0.357). By multivariate regression, increased age, positive surgical margins, nodal metastasis or unknown nodal status, higher histologic grade, and black race were associated with increased hazards for death. Conclusion Exenteration may be curative for well-selected women with uterine cancer, particularly among women with pathologically negative lymph nodes.