Cervical Stromal Invasion in Endometrioid Endometrial Carcinoma (EEC) Does Not Correlate with Overall Survival
S Sioletic, JP Orezzoli, A Olawaiye, AH Russell, M Del Carmen, E Oliva. Massachusetts General Hospital, Boston, MA
Background: EEC is the most common endometrial cancer, with stage being the most critical prognostic factor. Cervical involvement (CI), divided into IIA (epithelial involvement) and IIB (stromal invasion), overall is associated with decreased survival (70 vs 90%). However, the impact on prognosis of substages IIA vs IIB is unclear.
Design: 81 patients uniformly treated for stage II EEC were identified (1993-2003) in our institution. They were stratified into Group A (46) with available slides for review and Group B (35) with information obtained from the pathology report. In group A, 1 to 6 slides of cervix (mean 3) were reviewed. Tumors were classified as Stage IIA or IIB according to the most recent FIGO criteria. Stromal invasion (SI) in group A tumors was subclassified in 4 subgroups based on depth of invasion; A) 1 mm; B) > 1 mm and 3 mm; C) > 3 mm and 5 mm and D) > 5 mm. Other histopathologic parameters included grade, depth of myometrial invasion (MI), and lymphovascular invasion (LVI). Clinical data included age, type of surgery/ radiation, and survival. Statistical analysis was performed.
Results: Patients ranged in age from 33 91 (median 64) years. In group A, 11 patients had stage IIA and 35 stage IIB tumors. Depth of SI ranged from 0.1 to 1.2 (mean 0.34) cm (1 mm in 2, > 1 mm and 3 mm in 18, > 3 mm and 5 mm in 10 and > 5 mm in 5). In Group B, 15 patients had stage IIA and 20 stage IIB tumors with no further information regarding depth of SI. In group A, 12 EECs were Grade 1, 29 Grade 2 and 5 Grade 3. 31 tumors had < 50% MI while 15 had > 50% MI and LVI was present in 11. In Group B,13 tumors were Grade 1, 13 Grade 2, and 9 Grade 3. 21 had < 50% or no MI and 9 showed LVI. Median follow-up was 73 (range 5 210) months. Five and 10-year survival rates were 83% and 78% for patients with stage IIA and 71% and 65% for stage IIB EECs respectively. By univariate analysis, age, MI, LVI and type of treatment affected survival, while substaging or depth of SI did not. By multivariate analysis, only age (p=0.001), LVI (p =0.017), and type of treatment (p=0.022) were predictors of survival in stage II EECs.
Conclusions: This study showed that distinction between stage IIA and IIB or depth of SI do not affect survival in patients with EEC, suggesting that substaging should be eliminated.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 159, Wednesday Afternoon