Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA.
British Journal of Cancer (Impact Factor: 4.84). 04/2006; 94(5):642-6. DOI: 10.1038/sj.bjc.6603012
Source: PubMed


To compare the survival of women with uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CC) to those with grade 3 endometrioid uterine carcinoma (G3EC). Demographic, pathologic, treatment, and survival information were obtained from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001. Data were analysed using Kaplan-Meier and Cox proportional hazards regression methods. Of 4180 women, 1473 had UPSC, 391 had CC, and 2316 had G3EC cancers. Uterine papillary serous carcinoma and CC patients were older (median age: 70 years and 68 vs 66 years, respectively; P<0.0001) and more likely to be black compared to G3EC (15 and 12% vs 7%; P<0.0001). A higher proportion of UPSC and CC patients had stage III-IV disease compared to G3EC patients (52 and 36% vs 29%; P<0.0001). Uterine papillary serous carcinoma, CC and G3EC patients represent 10, 3, and 15% of endometrial cancers but account for 39, 8, and 27% of cancer deaths, respectively. The 5-year disease-specific survivals for women with UPSC, CC and G3EC were 55, 68, and 77%, respectively (P<0.0001). The survival differences between UPSC, CC and G3EC persist after controlling for stage I-II (74, 82, and 86%; P<0.0001) and stage III-IV disease (33, 40, and 54; P<0.0001). On multivariate analysis, more favourable histology (G3EC), younger age, and earlier stage were independent predictors of improved survival. Women with UPSC and CC of the uterus have a significantly poorer prognosis compared to those with G3EC. These findings should be considered in the counselling, treating and designing of future trials for these high-risk patients.

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Available from: Michael Hendrickson, Jan 20, 2015
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    • "Notably, 52–70% of type II cancers exhibit extrauterine spread at the time of surgery, compared with 4.6% of Type I tumours (Goff, 2005; Thomas et al, 2008; Yoon et al, 2010). Uterine-serous-carcinoma (USC), is the most biologically aggressive Type II tumour, accounts for 10% of all endometrial cancer and carries the poorest prognosis, with 5-year survival rates as low as 55% (Hamilton et al, 2006). The c-erbB2 gene is a member of the erbB receptor tyrosine kinase family, which consists of four transmembrane glycoproteins: erbB1, erbB2, erbB3 and erbB4. "
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    • "While early stage, low grade EEC is classically managed by curative hysterectomy, latestage EEC/type II endometrial cancers are associated with significant mortality due to their metastatic spread outwith the uterine corpus (Dedes et al, 2011; DeLeon et al, 2014). Difficulties still exist with the type I/II classification system in terms of prognosis: there is uncertainty as to whether grade 3 EECs should be classified as type I or type II carcinomas (Boruta et al, 2004; Hamilton et al, 2006; Soslow et al, 2007; Voss et al, 2012) while the prognostic significance of tumours with mixed type I/II histology remains the subject of debate (Patsavas et al, 2011; Roelofson et al, 2012). The existence of grade 1 EECs arising in a background of atrophic endometrium also presents difficulties for this dualistic model (Geels et al, 2012). "
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    • "These tumors are typically well differentiated, minimally invasive into the uterine wall, generally estrogen dependent, and have a good prognosis . In contrast, type II tumors, which are typically poorly differentiated, occur in older women, are usually diagnosed at advanced stage of the disease, and are characterized by an aggressive behavior and a worse prognosis (Hamilton et al., 2006). Uterine serous carcinoma (USC) constitutes the predominant histological class among type II tumors. "
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