Tumor Size as a Prognostic Factor in Uterine Serous Carcinoma: A Large Multi-Institutional Study
Sudeshna Bandyopadhyay, Koen K Van de Vijver, Esther Oliva, Marisa R Nucci, Dongping Shi, Faisal Qureshi, Kinda Hayek, Baraa Alosh, Zhuang Feng, Hayan Jaratli, Daniel Schultz, Rouba Ali-Fehmi. Wayne State University, Detroit, MI; Massachusetts General Hospital, Boston, MA; Henry Ford Health System, Detroit; Brigham and Women's Hospital, Boston, MA
Background: Uterine serous carcinomas (USC), while constituting 10% of all endometrial carcinomas, are responsible for a high mortality rate in these patients. Tumor size although often used by our colleagues is not a well defined prognostic variable. The goal of our study is to evaluate tumor size as a prognostic parameter and its association with other clinicopathologic parameters.
Design: After IRB approval, 236 USC from the Pathology databases of 4 large academic institutions were included. H&E slides (2-10 slides per case) were retrieved and reviewed by gynecologic pathologists at each participating institution after reviewing 50 cases together to be consistent in the diagnosis. Clinical and pathologic variables including tumor size (≤ 2 versus > 2 cm), myometrial invasion (MI), lymphovascular invasion (LVI), lymph node status and FIGO stage, recurrence, outcome and survival were recorded. Pearson Chi-Square tests were used to assess potential associations and survival data were generated using the Kaplan Meier method.
Results: Patients' mean age was 67.2 years (median: 67.00 years, range 47-82 years). Survival ranged from 0-184 months with a mean and median of 42.8 and 29.9 months respectively. 155 of 236 tumors were > 2 cm while 81 were ≤ 2cm in size. Significant correlation was seen between tumor size and LVI (p<.001) and with FIGO stage (p<.001). Analyzing Stage I, although not significant, there was a trend for tumors ≤2 cm to correlate with stage IA (44/90) compared to stage IB (4/16) (p=0.06). Finally, a higher recurrence rate was observed in patients with tumors > 2 cm (p=0.04). However, no association was found with lymph node status and overall survival.
|TUMOR SIZE ≤ 2 CM||TUMOR SIZE > 2 CM||p value|
|LVI||26/130 (20%)||104/130 (80%)||<.001|
|LN positive||13/51 (25.5%)||38/51 (74.5%)||.140|
|MI||46/181 (25.4%)||135/181 (74.6%)||<.001|
|Recurrence||15/61 (24.6%)||46/61 (75.4%)||.043|
|Stage I||48 (64%)||58 (38.6%)||<.001|
|Stage II||6 (8%)||13 (8.7%)||<.001|
|Stage III & IV||21 (28%)||79 (52.7%)||<.001|