Prognosis of papillary serous, clear cell, and grade 3 stage I carcinoma of the endometrium
Introduction
Endometrioid cancer when limited to the uterus has a very favorable outcome with 87.4% survival reported in the last Annual Report (AR) of FIGO [1]. The uterine papillary serous carcinoma (UPSC), an entity described by Lauchlan [2] and Hendrickson et al. [3] in the early 1980s, is well accepted as an endometrial subtype that carries a poor prognosis (70% at 5 years for stages I and II) [1]. Clear cell (CC), another relatively rare cancer of the endometrium, also carries a poor prognosis (50.8% at 5 years for stages I and II). One of the reported reasons for the poor prognosis of these two histotypes is the fact that both have a propensity for spreading outside of the uterus early in the disease process. It has only been in recent years, since endometrial cancer has become surgically staged, that the full extent of extant disease has been appreciated. Surgically staged UPSC and CC reports are very limited.
With an overall poor prognosis, definitive therapy has been evaluated without much success. Some investigators have suggested UPSC to be similar to serous ovarian carcinoma histologically and with a tendency to have intraperitoneal spread as a result chemotherapy should be used in contrast to the historical radiation therapy for extensive intrauterine as well as extant disease in endometrial cancer.
Endometrial cancer is usually limited to the uterus at the time of diagnosis. Surgical staging suggests about 75% of all endometrial cancers have disease limited to the corpus. As previously noted, the relatively poor prognosis of UPSC and CC is reportedly due to the fact that most of these cancers have already spread beyond the corpus. Some authors have suggested that if these rare tumor types are limited to the uterus, survival is reasonably good and equivalent to the grade 3 (G3) endometrial stage I cancers. Grade of endometrioid cancer is of prognostic significance. The AR noted 92% survival of stage I G1 cancers compared with 74% of stage I G3 [1].
Reports to date have evaluated only a small number of these patients with poor histotypes. Data concerning specific treatment after surgical staging are more limited. Therefore, this report evaluates a relatively large database of stage I UPSC, CC, and G3 cancers as reported by the last AR of FIGO.
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Materials and methods
The 25th AR of FIGO published in 20011 was used to identify surgically staged I endometrial cancer patients who were included in this database. There were 5694 surgically staged endometrial cancer patients enrolled. Of the 3996 (70%) stage I cancers, 148 were UPSC, 59 were CC, and 325 were grade 3 lesions. These patients were evaluated in regards to the substage within stage I. Adjuvant therapy after surgical staging as well as 5-year survival was evaluated. The relationship of UPSC, CC, and G3
Results
Grades 1 and 2 endometrial cancers represent by far the most common histologies for stage I cancers. UPSC and CC cancers represent only 5.2% of all stage I endometrial cancers while 8.1% are stage IG3 (Table 1). As stage increases, UPSC, CC, and G3 all increase as a percent of each stage while grades 1 and 2 cancer decrease. When stages are compared within a given histology, all (UPSC, CC, G1, 2, and 3) have more patients in stage I than other stages, although there are more patients with
Discussion
UPSC and CC are relatively infrequent but prognostically important. UPSC is said to represent up to 10% of all endometrial cancers with CC being less frequently seen. In one of the largest studies reported to date, UPSC was seen in 9% of cases and CC 3%[4]. In our study for all stages of endometrial cancer, UPSC and CC represent 6.9% of these cancers but only 5.2% in those patients with stage I. This number has remained constant (6.3–7.3%) for the last three ARs. The fact that 46% of those
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