The Prognostic Significance and Outcome of Patients with Grade 1 Stage 1 Endometrioid Endometrial Adenocarcinoma Involving the Lower Uterine Segment
Magdalena Bellis, J Charles Victor, Marjan Rouzbahman, Golnar Rasty. University of Toronto, Toronto, ON, Canada; University Health Network and LMP, University of Toronto, Toronto, ON, Canada
Background: It has been postulated that due to its proximity to the cervix involvement of the lower uterine segment by endometrial adenocarcinoma is a poor prognostic indicator of patient outcome. This study investigates whether lower uterine segment involvement (LUSI) is associated with poor prognostic histopathological features and whether it correlates with disease recurrence or decreased patient survival in women with Grade 1 Stage 1 disease.
Design: After receiving ethics approval from our institution, we studied 164 consecutive Grade 1, Stage 1 endometrial endometrioid adenocarcinomas from 2001 to 2010. Some cases included patients who underwent lymph node dissection. Our cohort was divided into two groups based on the presence or absence of LUSI and were compared with regard to prognostic factors using the Pearson χ2 test and disease-free survival or overall survival using Cox proportional hazard models and Kaplan-Meier product-limit curves.
Results: Seventy-two cases (44%) of all Grade 1 Stage 1 cases were positive for LUSI. The average follow-up time for the LUSI and non-LUSI groups was 35 and 27 months, and the rate of nodal dissection was 24% and 30% respectively. The average age of women positive for LUSI was 58 years, and 61 years for non-LUSI. There was a significant association between LUSI and lymph-vascular invasion (p=0.04), however no significant association with deep myometrial invasion (p=0.19), and involvement of adenomyosis by adenocarcinoma (p=0.38). Both univariate (HR = 1.70; 95% CI 0.30, 9.63; p = 0.547) and multivariable analysis (HR = 1.44; 95% CI 0.23, 9.12; p = 0.698) showed that patients with and without LUSI had similar rates of disease free or overall survival.
Conclusions: Lower uterine segment involvement of Grade 1, Stage 1 endometrial endometrioid adenocarcinomas is associated with higher lymph-vascular tumor invasion but not with higher recurrence rates or poorer overall patient survival. A larger cohort of patients may be necessary to conclude whether the poor prognostic histological parameters and patients outcomes are associated with the presence of LUSI.
Category: Gynecologic & Obstetrics
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 176, Monday Morning