Article Text

Download PDFPDF
Comparison of Survival Outcomes Between Patients With Malignant Mixed Mullerian Tumors and High-Grade Endometrioid, Clear Cell, and Papillary Serous Endometrial Cancers
  1. Ashley Sinclair Felix, PhD*,,
  2. Roslyn A. Stone, PhD,
  3. Robert Bowser, PhD§,
  4. Mamatha Chivukula, MD,
  5. Robert P. Edwards, MD,
  6. Joel L. Weissfeld, MD*, and
  7. Faina Linkov, PhD*,
  1. *Division of Cancer Prevention and Population Science, University of Pittsburgh Cancer Institute, Pittsburgh, PA;
  2. Department of Epidemiology,
  3. Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA;
  4. §Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA;
  5. Department of Pathology, and
  6. Department of Obstetrics and Gynecologic Oncology, Magee-Women's Hospital of UPMC Health System, Pittsburgh, PA.
  1. Address correspondence and reprint requests to Ashley Sinclair Felix, PhD, Division of Cancer Prevention and Population Science, University of Pittsburgh Cancer Institute, 5150 Centre Ave, Suite 4C, Pittsburgh, PA 15232. E-mail: asf23{at}


Introduction: Malignant mixed mullerian tumors (MMMTs) are an aggressive subtype of endometrial cancer (EC). Previous studies compare survival between high-grade endometrioid (EM), clear cell (CC), and papillary serous (PS) ECs; yet few studies compare MMMTs to these aggressive subtypes. The goal of this study was to compare recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) among EC subtypes.

Methods: We conducted a retrospective cohort study of EC cases treated at Magee-Women's Hospital between 1996 and 2008. Kaplan-Meier estimates of RFS, DSS, and OS as well as and log-rank tests were used to compare survival distributions between histologic subtypes. Cox regression was used to estimate hazard ratios for histologic subtypes, adjusted for other significant prognostic factors. Interactions between histologic subtype and prognostic factors were examined to assess effect modification.

Results: This cohort included 81 MMMT (15%), 254 high-grade EM (46%), 73 CC (13%), and 147 PS (26%) cases. Compared to high-grade EM (6%) and CC (7%) cases, relatively more MMMT (12%) and PS (12%) cases were nonwhite. Stage differed significantly among the subtypes, with 36%, 34%, 37%, and 51% of MMMT, high-grade EM, CC, and PS cases, respectively, diagnosed at advanced late stage (P < 0.001). Kaplan-Meier curves and log-rank tests showed similar RFS, DSS, and OS between MMMT, high-grade EM, CC, and PS cases stratified by stage. In adjusted Cox regression models, RFS and DSS were not significantly different between MMMT and other subtypes. High-grade EM cases had a significantly better OS compared to MMMT cases (HR, 0.63; 95% confidence interval [CI], 0.41-0.98).

Conclusions: This is the first retrospective study to suggest that certain survival outcomes are similar among MMMT, high-grade EM, CC, and PS subtypes. Other large-scale studies are needed to confirm these findings.

  • Mortality
  • Aggressive endometrial cancers
  • Carcinosarcoma

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Financial support for this research was provided by a National Institutes of Health grant R25-CA057703.