Prognostic factors in high-grade endometrial cancer: does subtype matter?

Objective: To assess the clinicopathologic features, prognostic factors, and survival of all histotypes of high-grade endometrial cancer. Materials and Methods: The authors performed a multicenter retrospective cohort study in 378 women with high-grade histotypes of endometrial cancer: 141 grade 3 endometrioid carcinomas (G3E), 65 clear-cell carcinomas (CCC), 95 uterine serous cancer (USC), and 77 carcinosarcomas (CS) diagnosed between 2001 and 2014. All patients underwent a hysterectomy and bilateral salpingo-oophorectomy as first-line treatment, and 254 subsequently had a lymphadenectomy. Demographic, histological, and survival data were abstracted from medical records. Disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier curves and Cox multivariate regression analysis. Results: The mean age was 68.7 ± 10.5 years and was similar in the four histotypes. USC and CS were diagnosed in an advanced stage more frequently than G3E and CCC (p < 0.01). After a median follow-up of 34.6 (interquartile range 16.6-73.6) months, DFS was lower in USC [adjusted hazard ratio (HR): USC 2.20, 95% confidence interval (CI) 1.38-3.52] and CS (2.6, 1.63-4.30) compared with G3E and CCC (1.35, 0.78-2.32). Similar results were observed in terms of OS. Independent predictor factors of DFS and OS were: age, USC, and CS histotypes, deep myometrial invasion (MI), advanced FIGO Stage, and p53 overexpression. Adjuvant chemo-radiation was an independent factor of good prognosis. Conclusions: High-grade EC histotypes have high rates of recurrence and mortality. There are differences among histotypes, as USC and CS are more aggressive than G3E and CCC.

Endometrial carcinoma; Survival; High-grade; Clinicopathologic prognostic factors; Outcomes

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