Clinicopathologic characteristics and prognosis comparison of the uterine high grade endometrial carcinomas
, 1, 2, 1, 3, 1
Abstract
Objectives: Grade 3 endometrioid adenocarcinomas (G3 EAC), type two endometrial carcinomas (Type 2 EC), and also
uterine carcinosarcomas (UCS) are considered as high-grade endometrial adenocarcinomas. The aim of this study was to
compare the clinicopathologic features and survival of patients with UCS, G3 EAC, Type2 EC.
Material and methods: We included two hundred and thirty-five patients in this study. Patients were divided into three
groups according to the type of tumor as uterine G3 EAC (group 1, n = 62), Type 2 EC (serous, clear and mixed types; group 2,
n = 93), and UCS (group 3, n = 80). We compared the groups according to age, initial symptom, surgical approach, stage,
myometrial invasion (MI), lymph node invasion (LNI), lymphovascular space invasion (LVSI), adjuvant therapy, and survival.
When comparing the survival outcomes the Kaplan-Meier analysis was performed.
Results: The groups were similar according to age, menopausal status, nulliparity, initial symptoms, stage, LVSI, and LNI.
Positive cytology was determined significantly more in group 3. There was a significant difference between the groups in
terms of myometrial invasion degree. Optimal cytoreduction was similar among the groups. The primary adjuvant treatment
was chemotherapy for UCS and Type2 EAC whereas radiotherapy was the main adjuvant treatment for G3 EAC. There
were no significant differences among the groups according to overall survival (OS) (p = 0.290).
Conclusions: Although the survival difference among the groups can not be revealed, these patients have different clinical
and pathological features and they should be considered as different groups.
Keywords: endometrial cancerhigh-grade endometrioid adenocarcinomaoverall survivaluterine carcinosarcomatype 2 endometrial cancer
References
- Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018; 68(1): 7–30.
- Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer. 2016; 26(1): 2–30.
- Amant F, Moerman P, Neven P, et al. Endometrial cancer. The Lancet. 2005; 366(9484): 491–505.
- Soslow RA, Tornos C, Park KJ, et al. Endometrial Carcinoma Diagnosis: Use of FIGO Grading and Genomic Subcategories in Clinical Practice: Recommendations of the International Society of Gynecological Pathologists. Int J Gynecol Pathol. 2019; 38 Suppl 1: S64–S74.
- Carlson JW, Nastic D. High-Grade Endometrial Carcinomas: Classification with Molecular Insights. Surg Pathol Clin. 2019; 12(2): 343–362.
- Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol. 1983; 15(1): 10–17.
- Murali R, Soslow RA, Weigelt B. Classification of endometrial carcinoma: more than two types. Lancet Oncol. 2014; 15(7): e268–e278.
- Kandoth C, Schultz N, Cherniack AD, et al. Cancer Genome Atlas Research Network. Integrated genomic characterization of endometrial carcinoma. Nature. 2013; 497(7447): 67–73.
- Talhouk A, McConechy MK, Leung S, et al. Confirmation of ProMisE: A simple, genomics-based clinical classifier for endometrial cancer. Cancer. 2017; 123(5): 802–813.
- de Boer SM, Powell ME, Mileshkin L, et al. PORTEC study group. Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial. Lancet Oncol. 2018; 19(3): 295–309.
- Kurman RJ, Carcangiu ML, Herrington S. et al. WHO classification of tumours of female reproductive organs. 4th ed. WHO Press, Lyon 2014.
- Cantrell LA, Blank SV, Duska LR. Uterine carcinosarcoma: A review of the literature. Gynecol Oncol. 2015; 137(3): 581–588.
- Piulats JM, Guerra E, Gil-Martín M, et al. Molecular approaches for classifying endometrial carcinoma. Gynecol Oncol. 2017; 145(1): 200–207.
- Bosse T, Nout RA, McAlpine JN, et al. Molecular Classification of Grade 3 Endometrioid Endometrial Cancers Identifies Distinct Prognostic Subgroups. Am J Surg Pathol. 2018; 42(5): 561–568.
- Stelloo E, Bosse T, Nout RA, et al. Refining prognosis and identifying targetable pathways for high-risk endometrial cancer; a TransPORTEC initiative. Mod Pathol. 2015; 28(6): 836–844.
- Kim SR, Cloutier BT, Leung S, et al. Molecular subtypes of clear cell carcinoma of the endometrium: Opportunities for prognostic and predictive stratification. Gynecol Oncol. 2020; 158(1): 3–11.
- Beinse G, Rance B, Just PA, et al. Identification of mutated group using a molecular and immunohistochemical classification of endometrial carcinoma to improve prognostic evaluation for adjuvant treatments. Int J Gynecol Cancer. 2020; 30(5): 640–647.
- McGunigal M, Liu J, Kalir T, et al. Survival Differences Among Uterine Papillary Serous, Clear Cell and Grade 3 Endometrioid Adenocarcinoma Endometrial Cancers: A National Cancer Database Analysis. Int J Gynecol Cancer. 2017; 27(1): 85–92.
- Bansal N, Herzog TJ, Seshan VE, et al. Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstet Gynecol. 2008; 112(1): 64–70.
- Bland AE, Stone R, Heuser C, et al. A clinical and biological comparison between malignant mixed müllerian tumors and grade 3 endometrioid endometrial carcinomas. Int J Gynecol Cancer. 2009; 19(2): 261–265.
- Zhu J, Wen H, Bi R, et al. Clinicopathological characteristics, treatment and outcomes in uterine carcinosarcoma and grade 3 endometrial cancer patients: a comparative study. J Gynecol Oncol. 2016; 27(2): e18.
- Felix AS, Stone RA, Bowser R, et al. Comparison of survival outcomes between patients with malignant mixed mullerian tumors and high-grade endometrioid, clear cell, and papillary serous endometrial cancers. Int J Gynecol Cancer. 2011; 21(5): 877–884.
- Ayeni TA, Bakkum-Gamez JN, Mariani A, et al. Comparative outcomes assessment of uterine grade 3 endometrioid, serous, and clear cell carcinomas. Gynecol Oncol. 2013; 129(3): 478–485.
- Hamilton CA, Cheung MK, Osann K, et al. Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers. Br J Cancer. 2006; 94(5): 642–646.
- Boruta DM, Gehrig PA, Groben PA, et al. Uterine serous and grade 3 endometrioid carcinomas: is there a survival difference? Cancer. 2004; 101(10): 2214–2221.
- Cirisano FD, Robboy SJ, Dodge RK, et al. The outcome of stage I-II clinically and surgically staged papillary serous and clear cell endometrial cancers when compared with endometrioid carcinoma. Gynecol Oncol. 2000; 77(1): 55–65.
- Creasman WT, Kohler MF, Odicino F, et al. Prognosis of papillary serous, clear cell, and grade 3 stage I carcinoma of the endometrium. Gynecol Oncol. 2004; 95(3): 593–596.
- Soslow RA, Bissonnette JP, Wilton A, et al. Clinicopathologic analysis of 187 high-grade endometrial carcinomas of different histologic subtypes: similar outcomes belie distinctive biologic differences. Am J Surg Pathol. 2007; 31(7): 979–987.
- Gulec UK, Paydas S, Gumurdulu D, et al. Are Uterine Grade 3 Endometrioid Adenocarcinoma and Carcinosarcoma Really Clinically Similar? Indian J of Gynecol Oncol. 2019; 17(2).
- Amant F, Cadron I, Fuso L, et al. Endometrial carcinosarcomas have a different prognosis and pattern of spread compared to high-risk epithelial endometrial cancer. Gynecol Oncol. 2005; 98(2): 274–280.
- George E, Lillemoe TJ, Twiggs LB, et al. Malignant mixed müllerian tumor versus high-grade endometrial carcinoma and aggressive variants of endometrial carcinoma: a comparative analysis of survival. Int J Gynecol Pathol. 1995; 14(1): 39–44.
- Zhang M, Yang TJ, Desai NB, et al. Comparison of outcomes in early stage uterine carcinosarcoma and uterine serous carcinoma. Gynecol Oncol. 2014; 135(1): 49–53.
- Zhang C, Hu W, Jia N, et al. Uterine carcinosarcoma and high-risk endometrial carcinomas: a clinicopathological comparison. Int J Gynecol Cancer. 2015; 25(4): 629–636.
- Prueksaritanond N, Chantape W. Comparative Survival Outcomes of Uterine Papillary Serous Carcinoma, Clear Cell Carcinoma, Grade 3 Endometrioid Adenocarcinoma, and Carcinosarcoma of Endometrial Cancer in Rajavithi Hospital. J Med Assoc Thai. 2016; 99 Suppl 2: S75–S83.
- Lakhwani P, Agarwal P, Goel A, et al. High-Grade Endometrial Cancer-Behaviour and Outcomes at a Tertiary Cancer Centre. Indian J Surg Oncol. 2019; 10(4): 662–667.
