Survival and prognostic factors of patients treated for Stage I to Stage III endometrial carcinoma in a reference cancer center in Southern Brazil

Purpose: To describe two- and five-year survival of patients with Stage I to III endometrial carcinoma and to identify prognostic factors.

Study design: Concurrent cohort study.

Patients and methods: Seventy-two patients were operated on by the same surgeon and followed up for at least two years. All the histopathological examinations were performed by the same pathologist. Survival was analyzed by the Kaplan-Meier method. Age, body mass index, tumor grade, myometrial invasion, histological type and stage were correlated with death.

Results: Overall survival at two and five years was 90.2% and 81.4%, respectively. By bivariate analysis, FIGO stage, myometrial invasion, tumor grade, histology, adnexal and/or lymph node metastasis and age were significant predictors of death (p < 0.05). Multivariate analysis revealed significant associations with death: FIGO Stage III (p = 0.001), histological type other than endometrioid (p = 0.027) and age 70 or more (p = 0.04).

Conclusion: Endometrial carcinoma Stage III patients, histological types other than endometrioid and age 70 years or more are at significant risk for death.

Endometrial carcinoma; Survival; Prognosis; Prognostic factors

[1] lnternationaI Agency for Research and Cancer (TARC). Cancer incidence, mortality and prevalence worldwide. Available from:http://www.iarc.fr.

[2] Creasman W.T., Odicino F.. Maisonneuve P., Beller U., Benedet J. L., Heintz A.P.M. et al.: "Carcinoma of the Corpus Uteri. 25'h Annual Report on the Results of Treatment in Gynecological Cancer". int. J. Gynecol. Obstet., 2003, 83 (suppl. I), 79.

[3] Steiner E., Eicher 0., Sagemiiller J., Schmidt M., Pilch H., Tanner B. et al.: "Multivariate independent prognostic factors in endome­trial carcinoma: a clinicopathologic study in 181 patients: 10 years experience at the Department of Obstetrics and Gynecology of the Mainz University". Int. J. Gynecol. Cancer, 2003, 13 (2), 197.

[4] Lindahl B., Einarsdottir M.. losif C.. Ranstam J., Willen R "Endometrial carcinoma: results of primary surgery on FIGO stages Ia-le and predictive value of histopathological parameter、“ Anticancer Res., 1997, /7 (3C), 2297.

[5] Mariani A., Webb M.J., Keeney G.L., Lesnick T.G.. Podratz K.C "Surgical Stage I endometrial cancer: predictors of distant failure and death". Gynecol. Oncol., 2002, 87, 274.

[6J Creutzberg C.L., van Pullen W.L., Warlan-Rodenhuis C.C., van den Bergh A.C.M., De Winter K.A.J.. Koper P.C.M. et al.: "Outcome of high risk stage IC, grade 3, compared with Stage I endometrial carcinoma patients: the Postoperative Radiation Therapy in Endometrial Carcinoma Trial". J. Clin. Oncol., 2004, 22, 1234.

[71 Sakuragi N., Hareyama H., Todo Y., Yamada H., Yamamoto R., Fugino T. et al.: ·'Prognostic significance of serous and clear cell adenocarcinoma in surgically staged endometrial carcinoma" Acta Ohstet. Gynecol. Scand., 2000. 79, 311.

l8J Boruta D.M. 2"', Gehrig P.A.. Groben P.A., Bae-Jump V., Boggess J.F., Fowler W.C. et al.:'' Uterine serous and grade 3 endometrioid carcinomas: is there a survival difference?". Cance,; 2004,101. 2214.

[9] Kaku T., Matsumura M., Sakai K., Tsuruchi N., Kamura T., Tsukamoto N. et al.: "Endometrial carcinoma in women 65 years of age or older: a clinicopathologic study". Eur. J. Gynaecol Oneal., 1996, 17, 357.

l10] Farley J.H.. Nycum LR., Birrer M.J.. Park R.C., Taylor R.R., "Age-sp ecific survival of women with endometrioid adenocarci- noma of the uterus". Gyneco/. Oneal., 2000. 79, 86.

[11] Bellino R.. Arisio R., D'Adatto F., Alba E., Attini R., Colla F. et al.: "Pathologic features of endometrial carcinoma in elderly women". Anticancer Res., 2001, 2/, 3721.

[12] Everett E., Tamimi H., Greer B., Swisher E., Paley P., Mandel L et al.: "The effect of body mass index on clinical/pathologic fea­tures, 、urgical morbidity, and outcome in patienls with endome­trial cancer". Gyneco/. Oneal., 2003, 90, 150.

[13] Studzinski Z., Zajewski W.:''Factors affecting the survival of 121 patients treated for endometrial carcinoma at a Po伈h hospital". Arch. Gynecol. Ohstet., 2003, 267, 145.

[14] Pavelka J.C., Ben-Sachar I., Fowler J.M., Ramirez N.C., Copeland L. J., Eaton L.A. et al.: "Morbid obesity and endometrial cancer: surgical, clinical, and pathologic outcomes in surgically managed patients". Gynecol. Oneal., 2004, 95, 588.

[15] Scholten A.N., Creutzberg C.L, Noordijk E.M.. Smit VT.: "Long­term outcome in endometrial carcinoma favors a two-instead of a three-tiered grading system". Int. J. Radiat. Oncol. Biol. Phys., 2002, 52, 1067.

[16] Pitson G., Colgan T., Levin W., Lockwood G., Manchul L., Milosevic L. et al.: "Stage II endometrial carcinoma: prognostic factors and risk classification in 170 patients". Int. J. Radiat. Oncol. Biol Phys., 2002, 53, 862.

l17] Feltmate C.M.. Duska LR., Chang Y., Flynn C.E., Nikrui N., Nig­gun du E. et al.: "Predictors of recurrence in surgical stage II endometrial adenocarcinoma''. Gvneco/. Oneal., 1999, 73, 407.

[18] Connel P.P., Rotmensch J.. Waggoner S.. Mundt A.J.: "The signif­icance of adnexal involvement in endometrial carcinoma". Gynecol. Oncol., 1999, 74, 74.

[19] Humber C., Tierney J., Symonds P., Collingwood M., Kirwan J., Williams C. et al.: "Chemotherapy for advanced, recurrent or metastatic endometrial carcinoma. (Cochrane Review)". In: The Cochrane Library, Issue I. 2006. Oxford, Update Software.

[20] Rosenberg P., Boeyrd B., Simon、en E.: "A new agressive treat­ment approach to high grade endometrial cancer of possible benefit to patients with Stage I uterine papi11ary cancer". Gynecol. Oneal., 1993, 48, 32.

[21] Wilson T.0.. Podratz K.C., Gaffey T.A., Malkasian G.D., O'Brien P.C., Naessens J.M.:''Evaluation of unfavourable histologic sub­types in endometrial adenocarcinoma". Am. J. Ohstet. Gynecol.. 1990, /62、418.

[22] Goff B.A., Kato D., Schmidt R.A., Ek M., Fen-y J.A.. Muntz H.G. et al.: "Uterine papillary serous carcinoma: Patterns of metastatic spread". Gynecol. Oncol., I 994, 54, 264.

[231 Alektiar K.M.. Venkatraman E., Chi D.S.. Barakat R.R.: "Intrav­aginal brachytherapy alone for intermediate-risk endometrial cancer". Int. J. Radial. Oncol. Biol. Phys., 2005. 62, 11 I.