Prognostic Factors in Clear Cell Carcinoma of the Endometrium: A Clinicopathologic Analysis of 50 Rigorously Classified Cases
Oluwole Fadare, Wenxin Zheng, Marta A Crispens, Howard W Jones III, Dineo Khabele, Katja Gwin, Sharon X Liang, Khaled Mohammed, Mohamed M Desouki, Vinita Parkash, Jonathan L Hecht. Vanderbilt University, Nashville, TN; University of Arizona, Tucson, AZ; University of Chicago, Chicago, IL; North Shore-LIJ, NHP, NY; UPMC, Pittsburgh, PA; Yale University, New Haven, CT; Harvard University, Boston, MA
Background: Clear cell carcinoma of the endometrium (CCC) is an uncommon histotype whose analyses have generally been hampered by its rarity and issues of interobserver diagnostic variability. In this study, we analyzed the clinicopathologic features of 50 CCCs that were assembled from multiple institutions and which we considered to be morphologically unambiguous after a rigorous, multi-layered review process for diagnostic accuracy.
Design: A wide variety of morphologic and other clinicopathologic features were assessed for any potential relationships with with patient outcomes.
Results: The median patient age was 67 years. FIGO stage distibution was as follows: stage I (n=19), stage II (n=8), stage III (n=14), stage IV (n=9). The 5-year progression-free survival (PFS) for the entire cohort was 61%, and was 88%, 75%, 22% and 28.6% for stages I to IV respectively. On univariate analyses, age >65 years, advanced FIGO stage, and the presence of any lymph node metastases were associated with reduced PFS (p=0.02, 0.002, and 0.002 respectively). There was a trend to reduced PFS for patients with Yamamoto architectural grade C tumors (at least 10% of the tumor composed of solid masses or individual infiltrating tumor cells, but this was not statistically significant (p=0.09). On multivariate analyses, the only variable associated with reduced PFS was patient age >65 years. The 5-year overall survival (OS) for the entire cohort was 78%, and was 94%, 87.5%, 66.7%, and 42.8% for stages I to IV respectively. On univariate analyses, the following factors were associated with reduced OS: age >65 years (p=0.04), advanced FIGO stage (p=0.003), distant metastases (p=0.003), myometrial invasion >30% (p=0.01), a mitotic index of greater than 4 (p=0.014), and Yamamoto architectural grade C (p=0.02). On multivariate analyses, only age >65 years and advanced FIGO stage were associated with reduced OS (p=0.023 and 0.022 respectively).
Conclusions: Age and stage are the principal prognostic factors in CCC. However, our findings suggest that there may be prognostically relevant subsets of CCC that are definable by their pathologic features. Our analysis of this group of morphologically unambiguous CCC indicates that patient outcomes are more favorable than has previously been reported for this histotype.
Category: Gynecologic & Obstetrics
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 115, Tuesday Morning