or lymph node metastasis?

S104

ABSTRACTS / Gynecologic Oncology 120 (2011) S2–S133

This multisite retrospective analysis comprised women with uterine LMS treated at five academic centers between June 1981 and August 2010. Clinical, pathologic and treatment data were collected. Adjuvant treatment groups were defined as observation (OBS), radiation therapy (RT) and chemotherapy (CT). Kaplan–Meier curves were constructed for progression-free survival and overall survival, and multivariate analyses using logistic regression and Cox hazards ratios were performed. Results: One hundred eighty-one patients were identified. Median age was 55 years. One hundred twenty of 181 (66.3%) patients had stage I/II disease, 51 of 181 (28.2%) had stage III/IV disease, and 10 of 181 (5.5%) were not staged. All patients underwent primary surgery followed by OBS (31.5%), RT (25.4%), or CT (43.1%). With a median follow-up of 41 months, 109 of 181 (60.2%) patients recurred, and there was no difference between treatment groups (P = 0.212). Recurrences were pelvic (26/109, 23.9%), distant (62/109, 56.9%), or pelvic and distant (18/109, 16.5%); 60% of distant recurrences were in the lung. Salvage was achieved in 36.7% of patients including 50% (13/ 26) of those with pelvic recurrences and 33.9% (21/62) of those with distant recurrences (P = 0.156); 76.2% of patients with salvaged distant recurrences had lung recurrence only. Patients who recurred received a variety of therapies including surgery, CT, RT, and hormonal therapy. Of the 26 patients with pelvic recurrences, salvage was achieved in 7 who underwent surgery with or without additional therapy, in 8 of 9 who received CT with or without additional therapy, and in 4 of 4 who received both surgery and CT. For distant recurrences (lung and other), there was no difference in rate of salvage among different treatment groups (P = 0.764). Median time from recurrence to death was 12 months, and median length of salvage was 23 months. Median progression-free survival and overall survival were 57 and 81 months. Conclusions: Despite the biologic aggressiveness and lethality of LMS, our data suggest that a surprising number of recurrences were locoregional and amenable to salvage. Pelvic recurrences are more likely to be salvaged than distant recurrences. The role of surgery for isolated pelvic recurrences is less clear. Prospective studies are needed. doi:10.1016/j.ygyno.2010.12.247

Poster Area 4 Cervical Cancer, Cervical Cancer Clinical Trials, Gestational Trophoblastic Disease/Vulvar and Vaginal Cancers/Rare Tumors/Sarcomas and Public Health/Epidemiology: Abstracts 241–293 Sunday, March 6 – Tuesday, March 8, 2011 Exhibit Hall – Bonnet Creek Ballroom Cervical Cancer 241 2008 FIGO stage IIA1 and IIA2 cervical cancer: Does the new staging system predict survival and/or lymph node metastasis? G. Garg1, J. Shah2, R. Morris1 1 Wayne State University/Detroit Medical Center, Detroit, MI, 2Southern California Permanente Medical Group, Irvine, CA Objective: In 2008, the FIGO staging system for cervical cancer was revised, subdividing stage IIA cervical cancer into stages IIA1 and IIA2, based on tumor size (≤4 cm and >4 cm, respectively). The objective of this study was (1) to determine the correlation of 2008 FIGO staging system with survival and lymph node metastasis in patients with stage IIA cervical cancer, (2) to elucidate the treatment patterns in stage IIA1 and stage IIA2 cervical cancer, and (3) to investigate whether radical hysterectomy or radiation influenced overall survival.

Data were extracted from the Surveillance, Epidemiology, and End Results database between 1988 and 2005. Statistical analysis used χ2 test, Kaplan–Meier method, Cox regression, and logistic regression. Results: Of the 560 women, 271 (48.4%) had stage IIA1 and 289 (51.6%) stage IIA2 cervical cancer. Stage IIA2 patients were younger than stage IIA1 patients (mean age: 49 years vs 54 years, P = 0.01). Stage IIA1 and stage IIA2 differed significantly with respect to the administration of primary radiation (46.5% vs 64.4%, P < 0.001) and adjuvant radiation (60.5% vs 77.5%, P = 0.006). The incidence of adjuvant radiation following radical hysterectomy was high (48% [tumor size ≤2 cm] to 85% [tumor size >6 cm]). Five-year overall survival did not significantly differ between stages IIA1 and IIA2 (65.8% vs 59.5%, P = 0.2). Although age (P = 0.004), tumor size (P = 0.01), and lymph node status (P = 0.001) were all predictors of survival, only tumor size (P = 0.03) was significantly associated with lymph node metastasis. The 2008 FIGO stage was an independent predictor of neither survival nor lymph node metastasis (P > 0.05). Patients < 65 years of age with tumors ≤2 cm of nonsquamous histology commonly underwent radical hysterectomy. When other contributing factors were controlled for, there was no significant difference in survival between patients treated by radical hysterectomy and those treated with primary radiation (P > 0.05). Conclusions: The 2008 FIGO staging criteria do not constitute an independent predictor of survival or lymph node metastasis in stage IIA cervical cancer. Given the equivalent efficacy of radical hysterectomy and radiation, attention should be paid to the high risk of adjuvant radiation in these patients. doi:10.1016/j.ygyno.2010.12.248

242 Adenocarcinoma as an independent risk factor for early-stage intermediate-risk cervical carcinoma C. Mathews1, S. Goodrich2, R. Farrell1, C. DeSimone2, L. Seamon2, L. Landrum1 1 University of Oklahoma, Oklahoma City, OK, 2Lexington Gynecologic Oncology, Lexington, KY Objective: The observation arm of GOG 92 showed that the probability of recurrence was higher for cervical adenocarcinoma than for squamous cell cancer (SCC). Adjuvant radiation therapy appeared to benefit adenocarcinoma more than SCC, but the number of subjects with adenocarcinoma was small. This analysis will examine recurrence probability among subjects with IB adenocarcinoma who received no adjuvant treatment to determine whether histology should be considered as an intermediate-risk factor. A retrospective review was performed of patients with stage IB cervical adenocarcinoma treated with hysterectomy and lymphadenectomy at two institutions between 1990 and 2007. Inclusion was limited to those with negative parametria, margins and lymph nodes who received no postoperative treatment. Subjects who met intermediate-risk criteria based on GOG 92 were also excluded. Subjects with one intermediate-risk (IR) factor, including positive lymphovascular space invasion (LVSI), tumor size >4 cm, or middle-/outer-third invasion, were compared with subjects with no risk (NR) factor. Fisher's exact test and the Cochran– Armitage trend test were used to compare recurrence risk among pathologic factors. Results: We identified 91 patients with stage IB cervical adenocarcinoma with negative parametria, margins, and lymph nodes who did not receive postoperative treatment. The median age was 40 years, median follow-up was 3.1 years and 34 of 91 patients had an IR factor. The risk of recurrence was 5.9% (2/34) in the IR group and 1.7% (1/57) in the NR group (0.553). The relative risk of recurrence was 16.2