Prognostic factors in endometrial cancer Stages III and IV: a single academic institution experience of 49 patients

Background: To evaluate the clinical and pathologic factors associated with survival in patients with advanced staged endometrial carcinoma. Matreials and Methods: Between 2005 and 2017 all patients with endometrial carcinoma type I were identified from tumor registry databases at this Academic hospital. The impact of clinical and pathologic risk factors on the survival of patients with endometrial carcinoma was evaluated using Kaplan-Meier life table analyses and log-rank tests. Results: Forty-nine patients with advanced endome-trial cancer were collected. The median progression-free survival (PFS) for all patients was 42 months whereas the median overall sur-vival (OS) was 69 months for all patients. Univariate analysis was extended to all prognostic factors for all stages showed as statistically significant positive cytology and cervical invasion, whereas for Stage III only cervical invasion. For Stage IIIA the prognostic factors statistically significant were cervical invasion and lymphovascular space invasion (LVSI). Furthermore, prognosis was worse in tumors belonging to Stage IV with positive cytology. Conclusion: Prognostic factors related to a lower survival rate in advanced stages of en-dometrial cancer are represented by cervical invasion, LVSI, and positive peritoneal cytology. These factors with respect to LVSI and positive peritoneal cytology should be included in FIGO 2009 surgical staging system because associated to a poor prognosis.

Prognostic Factors; Uterine carcinoma; Endometrial carcinoma.

[1] Jemal A., Siegel R., Ward E HY, Xu J., Murray T., M.J. T. Cancer statistics, 2008. CA Cancer J. Clin., 2008, 58, 71.

[2] Creutzberg C.L., van Putten W.L., Koper P.C., Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis C.C., et al.: “Surgery and postoperative ra-diotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma”. Lancet, 2000, 22,1404.

[3] Potish R.A., Twiggs L.B., Adcock L.L., Konald A..Prem M.D.: “Role of whole abdominal radiation therapy in the management of endome-trial cancer: Prognostic importance of factors indicating peritoneal metastases”. Gynecol. Oncol., 1985, 21, 80.

[4] Solmaz U., Mat E., Dereli M.L., Turan V., Ekin A., Tosun G., Dogan A., et al.: “Stage III and IV endometrial cancer: A single oncology centre review of 104 cases”. J. Obstet. Gynaecol., 2016, 36, 81.

[5] Wang P.H., Wen K.C., Yen M.S.: “Challenges in the management of recurrent endometrial cancer”. J. Chin. Med. Assoc., 2016, 79, 171.

[6] Chan J.K., Sherman A.E., Kapp D.S., Zhang R., Osann K.E., Maxwell L., et al.: “Influence of gynecologic oncologists on the survival of patients with endometrial cancer”. J. Clin. Oncol., 2011, 29, 632.

[7] NCCN clinical Practice Guidelines in Oncology (NCCN Guide-lines): “Uterine neoplasm. Version 2.2016”.

[8] Jamison P.M., Altekruse S.F., Chang J.T., Zahn J., Lee R., Noone A. M., Barroilhet L.: “Site-specific factors for cancer of the corpus uteri from SEER registries: collaborative stage data collection sys-tem, version 1 and version 2”. Cancer, 2014, 120, 3836.

[9] Pecorelli S., Creasman W., Pettersson F., Benedet J.L., Shaperd J.H.: “FIGO annual report on the results of treatment in gynecologic can-cer”. J. Epidemiol. Biostat., 1998, 3, 35.

[10] Berman M.L., Ballon S.C., Lagasse L.D., Watring W.G.: “Prognosis and treatment of endometrial cancer”. Am. J. Obstet. Gynecol. Oncol., 1984, 136, 679.

[11] Boronow R.C., Morrow C.P., Creasman W.T., Disaia P.J., Silverberg S. G., Miller A., Blessing J.A.: “Surgical staging in endometrial can-cer: clinical pathologic findings of a prospective study”. Obstet. Gy-necol., 1984, 63, 825.

[12] Creasman W.T., Morrow C.P., Bundy B.N., Homesley H.D., Graham J. E., Heller P.B.: “Surgical pathologic spread patterns of endometrial cancer. A gynecologic Oncology Group Study”. Cancer, 1987, 60, 2035.

[13] Gal D., Recio F.O., Zamurovic D., Tancer M.L.:”Lymphvascular space involvement - a prognostic indicator in endometrial adenocar-cinoma”. Gynecol. Oncol., 1991, 42, 142.

[14] Larson D.M., Connor G.P., Broste S.K., Krawisz B.R., Johnson K. K.: “Prognostic significance of gross myometrial invasion with endometrial cancer”. Obstet. Gynecol., 1996, 88, 394.

[15] Mazurka J.L., Krepart G.V., Lotocki R.J.: “Prognostic significance of positive peritoneal citology in endometrial carcinoma”. Am. J. Obstet. Gynecol., 1988, 158, 303.

[16] Obermair A., Geramou M., Tripcony L., Nicklin J.L., Perrin L., Crandon A.J.: “Peritoneal cytology: impact on disease-free sur-vival in clinical stage I endometrioid adenocarcinoma of the uterus”. Cancer Lett., 2001, 164, 105.

[17] McLellan R., Dillon M.B., Currie J.L., Rosenshein N.B.: “Peritoneal cytology in endometrial cancer: a review”. Obstet. Gynecol. Surv., 1989, 44, 711.

[18] Lurain J.R.: “The significance of positive peritoneal cytology in en-dometrial cancer”. Gynecol. Oncol., 1992, 46, 143.

[19] Kadar N., Homesley H.D., Malfetano J.H.: “Positive peritoneal cytol-ogy is an adverse factor in endometrial carcinoma only if there is other evidence of extrauterine disease”. Gynecol. Oncol., 1992, 46, 145.

[20] Grimshaw R.N., Tupper W.C., Fraser R.C., Tompkins M.G., Jeffrey J. F.: “Prognostic value of peritoneal cytology in endometrial carci-noma”. Gynecol. Oncol., 1990, 36, 97.

[21] Creasman W.T., Odicino F., Maisonneuve P., Beller U., Benedet J. L., Heintz A.P., et al.: “Carcinoma of the corpus uteri”. Int. J. Gy-naecol. Obstet., 2003, 83, 79.

[22] Pecorelli S.: “Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium”. Int. J. Gy-naecol. Obstet., 2009, 105, 103.

[23] Morrow C.P., Bundy B.N., Kurman R.J., Creasman W.T., Heller P., Homeseley H.D., Graham J.E.: “Relationship between surgical-pathological risk factors and outcome in clinical stage I and II car-cinoma of the endometrium: a Gynecologic Oncology Group Study”. Gynecol. Oncol., 1991, 40, 55.

[24] Chen J.R., Chang T.C., Fu H.C., Lau H.Y., Chen I.H., Ke Y.M., et al.: “Outcomes of patients with surgicopathologically staged IIIA-IVB pure endometrioid-type endometrial cancer”. Medicine, 2016, 95, 1.