The results suggest that G3 EAC has a slightly more favorable survival than UPSC and CC but predictably does poorer than G1–2 EAC. Further research is warranted to determine if G3 EAC should be reclassified as a type 2 cancer.
Mary McGunigal, Jerry Liu, MD, Manjeet Chadha, MD, Vishal Gupta, MD; Icahn School of Medicine at Mount Sinai
OBJECTIVES: High-risk histologies, including uterine papillary serous cancer (UPSC), clear cell (CC) cancer, and high-grade (G3) endometrioid adenocarcinoma (EAC), have a worse prognosis compared with G1–2 EAC. It is unknown whether G3 EAC outcomes are more similar to those of UPSC/CC or G1–2 EAC. The purpose of this study was to compare overall survival (OS) among UPSC, CC, and G1–3 EAC for International Federation of Gynecology and Obstetrics (FIGO stages) I–III.
METHODS: The National Cancer Data Base (NCDB) was queried for patients diagnosed with FIGO (1988 classification) stage I–III UPSC, CC, and EAC from 1998–2009 who underwent surgery as definitive treatment. Patients with unknown grade/stage, nonsurgical primary therapy, other histologies, and < 30 days of follow-up were excluded. OS was calculated using the Kaplan-Meier product-limit method and compared using log-rank tests.
RESULTS: Of the 461,307 patients in the endometrial cancer database, a total of 109,336 patients met our inclusion criteria. For patients with stage I disease (n = 95,432), the 5-year OS was 92.3% for G1 EAC, 86.3% for G2 EAC, 74.4% for G3 EAC, 68.7% for CC, and 68.0% for UPSC. For stage II patients (n = 6,519), the 5-year OS was 85.9% for G1 EAC, 77.3% for G2 EAC, 60.5% for G3 EAC, 53.9% for CC, and 50.2% for UPSC. For stage III patients (n = 7,385), the 5-year OS was 78.3% for G1 EAC, 65.0% for G2 EAC, 43.5% for G3 EAC, 36.1% for CC, and 30.7% for UPSC (P values for log-rank tests of equality over strata < .0001). On multivariate analysis, black race, age ≥ 60 years, higher stage, higher grade, high-risk histologies, receipt of chemotherapy, and higher comorbidity scores were all significantly (P < .0001) predictive of death.
CONCLUSIONS: The results suggest that G3 EAC has a slightly more favorable survival than UPSC and CC but predictably does poorer than G1–2 EAC. Further research is warranted to determine if G3 EAC should be reclassified as a type 2 cancer.
Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org