The Outcome of Stage I–II Clinically and Surgically Staged Papillary Serous and Clear Cell Endometrial Cancers When Compared with Endometrioid Carcinoma

• Published in: Gynecologic oncology 2000-04, Vol.77 (1), p.55-65
• Main Authors: Cirisano, Frank D., Robboy, Stanley J., Dodge, Richard K., Bentley, Rex C., Krigman, Hannah R., Synan, Ingrid S., Soper, John T., Clarke-Pearson, Daniel L.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma, Clear Cell - mortality; Adenocarcinoma, Clear Cell - pathology; Adenocarcinoma, Clear Cell - surgery; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Endometrioid - mortality; Carcinoma, Endometrioid - pathology; Carcinoma, Endometrioid - surgery; clear cell carcinoma; Cystadenocarcinoma, Papillary - mortality; Cystadenocarcinoma, Papillary - pathology; Cystadenocarcinoma, Papillary - surgery; endometrial cancer; Endometrial Neoplasms - mortality; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Hysterectomy; Medical sciences; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; papillary serous carcinoma; Prognosis; Survival Analysis; Tumors
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1006/gyno.2000.5737

Purpose. The aim of this study was to compare survival and recurrence in clinical and surgical stage I–II papillary serous (PS), clear cell (CC), and endometrioid (EM) cancers of the endometrium and examine the prognostic utility of myometrial invasion. Methods. Clinical, surgicopathologic, and survival data were retrospectively collected on 574 clinical stage I–II endometrial cancer patients, including 53 PS and 18 CC (based on postoperative histology), undergoing hysterectomy at Duke University Medical Center between 1967 and 1990. All staging material was available and reexamined prior to this analysis, and FIGO surgical staging was retrospectively assigned. Prognostic variables examined included age, stage, grade, myometrial invasion, lymph–vascular space invasion (LVSI), and histology. PS and CC histologic subtypes were compared as both common category and discrete categories versus EM, EM grade 1 (EM1), EM grade 2 (EM2), and EM grade 3 (EM3). Statistical analyses were performed using χ2, Fisher's exact, and Wilcoxon rank sum tests, Cox regression analysis, and Kaplan–Meier survival analysis. Results. PS tumors accounted for 9%, CC for 3%, and EM for 88% of cases. Recurrences were more frequent among PS (38%) and CC (22%) compared with EM (9%) (P < 0.001 and 0.08, respectively), and PS recurred more frequently than EM3 alone (20%) (P = 0.06). Among PS, CC, and EM3 patients with recurrences there were no statistical differences in the proportion that received preoperative or postoperative radiotherapy or chemotherapy. Prognostic factors for shorter survival included age >=60, surgical stage III+IV, presence of LVSI, histology (PS, CC, or EM3), and >=50% myometrial invasion. The estimated 5-year survival of PS+CC patients with