[1152] What Predicts Recurrence in Low-Stage Endometrial Endometrioid Carcinoma? A Clinicopathological Review of 159 Cases

Sarika Gupta, Supriya Srivastava, Diana Lim. National University Health System, Singapore, Singapore; Cancer Science Institute, Singapore, Singapore

Background: Even though most patients with low-stage endometrial endometrioid carcinomas (EEC) have favorable prognosis, some develop recurrent disease. We reviewed a series of low-stage EEC, with the aim of identifying additional prognostic parameters in patients with poor outcome.
Design: All low-stage EEC diagnosed between 2000 to 2010 were reviewed to evaluate: tumor grade, depth and pattern of myoinvasion {infiltrating glands (IG), pushing front (PF), microcystic elongated and fragmented (MELF) or adenoma malignum-like (AM)}, lymphovascular invasion (LVI), cervical and lower uterine segment involvement (LUSI). Clinical follow-up data was obtained from the electronic patient records.
Results: 159 cases of low-stage EEC were identified (127 grade 1, 24 grade 2 and 8 grade 3). 156 patients underwent THBSO and 3 had hysterectomy. 101 and 88 patients also had pelvic lymphadenectomy and peritoneal washings performed, respectively. Tumor size ranged from 0.4 to 10 (mean 4.1) cm. 123 cases (77.4%) were stage 1A, 25 (15.7%) stage 1B and 11 (6.9%) stage 2. 74 and 31 tumors showed < and > 50% myoinvasion. The invasive pattern consisted of IG (73; 69.5%), PF (21; 20.0%), MELF (9; 8.6%) and AM (2; 1.9%). 47 tumors had LUSI and 15 demonstrated cervical involvement (4 glandular, 2 stromal and 9 with glandular and stromal involvement). LVI was identified in 24 tumors. 74/127 (58.3%) grade 1, 23/24 (95.8%) grade 2 and all 8 (100%) grade 3 tumors showed myoinvasion. Higher FIGO grade (2 and 3) tumors were associated with cervical stromal involvement (p=0.012) but no association between grade and pattern of myoinvasion or LUSI was identified. The average length of follow-up was 59.2 (range 1-147) months. 150 (94.3%) patients were alive and well, 1 was alive at 8 months but developed supraclavicular lymph node metastasis, 2 died of disease (1 at 31 months with vault, lung and abdominal lymph nodes metastases and another at 25 months with hip, pelvic and inguinal nodes and costophrenic sulcus metastases), and 6 died of other causes. All patients with recurrence had myoinvasive disease with IG invasion {2/3 stage 1A (grade 1 and 2), 1/3 Stage 1B (grade 3)} and LUSI and 2 had LVI. The patient with a grade 1, stage 1A tumor also has cervical glandular involvement.
Conclusions: Patients with low-stage EEC generally have excellent prognosis. Tumors with higher FIGO grade, LUSI, LVI, and an IG pattern of invasion were associated with disease recurrence.
Category: Gynecologic & Obstetrics

Wednesday, March 6, 2013 1:00 PM

Poster Session VI # 201, Wednesday Afternoon


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