Lower Uterine Segment Involvement in Low Grade Endometrioid Endometrial Adenocarcinoma: A Predictor of Disease Progression and Survival
Laleh Hakima, Lorna Ogden, Martin Feuerman, Christopher Bondoc, Jeannine Villella, Poonam Khullar. Winthrop University Hospital, Mineola
Background: The clinicopathologic significance of lower uterine segment involvement (LUSi) in management of patients with endometrial adenocarcinoma remains controversial. Although the presence of LUSi is not incorporated into the FIGO staging system as an independent criterion, recent studies have found significant associations with other FIGO prognostic factors. However, an association with adverse clinical outcomes has yet to be elucidated. We investigated the prognostic significance of LUSi in patients with low grade endometrioid endometrial adenocarcinoma, focusing on its association with staging criteria and clinical outcomes, specifically recurrence-free survival (RFS) and overall survival (OS).
Design: Surgical pathology archives of endometrial adenocarcinoma from 2004-2009 were reviewed. Of 417 patients, 294 met inclusion criteria and 130 were excluded due to high grade/aggressive histologic subtypes; synchronous gynecological carcinomas; neoadjuvant therapy. Prognostic data including tumor histology, myometrial invasion, LUSi, lymphovascular invasion (LVI), nodal metastasis, and FIGO stage were recorded. Fisher's exact, Chi-square, and rank-sum tests were used to evaluate the association of LUSi with other prognostic data. Kaplan Meier analysis was used to assess the relationship of LUSi with OS and RFS.
Results: LUSi was present in 95 patients (32.3%) with low grade endometrioid adenocarcinoma. LUSi was associated with presence of LVI (p <0.0001), >50% myometrial invasion (p <0.0001), and grade 2 tumors (p =0.0056). There were 12 local recurrences and no disease-related deaths. Nine patients (10.23%) with LUSi had local recurrence compared with 3 patients (1.79%) without LUSi (p=0.004). RFS at 5 years was 69.5% for patients with LUSi compared with 98.9% for patients without LUSi (p=0.0022).
Conclusions: The presence of LUSi in patients with low grade endometrioid endometrial adenocarcinoma is associated with significantly decreased RFS and is significantly associated with lymphovascular invasion. Lower uterine segment involvement should be considered a poor prognostic indicator in operative management with regard to surgical staging and clinical treatment.
Category: Gynecologic & Obstetrics
Monday, March 19, 2012 8:15 AM
Platform Session: Section E, Monday Morning