Grade 1 Endometrioid Carcinoma With an Area of Serous Carcinoma Less than 5% Is More Aggressive than Stage IA Pure-type Grade 1 Endometrioid Carcinoma

Abstract Background The incidence of grade 1 endometrioid carcinoma (EG1) at 2009 International Federation of Obstetrics and Gynecology (FIGO) stage IA was the highest in endometrial carcinoma. Several studies and guidelines classified EG1 into recurrent low risk and did not recommend patients received adjuvant therapy. However, not a few case with EG1 recurred. The aim of this study was to examine whether EG1 at 2009 FIGO stage IA with a less than 5% serous component resembling ovarian high- or low-grade serous carcinoma (SC) was a risk factor for recurrence or worse progression free survival (PFS). Methods Between 1990 and 2015, patients who received total abdominal hysterectomy and bilateral salpingo-oophorectomy for grade 1 endometrioid carcinoma at stage IA were enrolled at multiple centers. In addition to pathological review using 2014 World Health Organization (WHO) criteria, SC and several pathological features, including lympho-vascular invasion, were identified. A retrospective analysis to examine whether SC was a risk factor of recurrence was conducted. Results During the observational period, 236 patients were included in our study. Among them, SC was noted in 14 patients. Five patients showed recurrence and 4 of them had SC. Multivariate analysis for recurrence revealed that SC was an independent risk factor of recurrence (hazard ratio (HR) 139, p<0.001). PFS of patients with SC was worse than of patients without SC (p<0.001). Multivariate analysis for PFS demonstrated that SC was a significant prognostic factor (HR 98.9, p<0.0001). Conclusion SC was the strongest risk factor of recurrence for patients with EG1 at FIGO stage IA. Therefore, a new treatment strategy may be needed for patients with SC.

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Brain metastasis in two patients with stage IA papillary serous carcinoma of the uterus

Gynecologic Oncology Reports ◽

10.1016/j.gore.2015.04.002 ◽

2015 ◽

Vol 13 ◽

pp. 1-4

Author(s):

Deepa M. Narasimhulu ◽

Neekianund Khulpateea ◽

Keith Meritz ◽

Yiquing Xu

Keyword(s):

Brain Metastasis ◽

Serous Carcinoma ◽

Stage Ia ◽

Papillary Serous Carcinoma

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Chemotherapy as single modality treatment for stage IA uterine papillary serous carcinoma

Gynecologic Oncology ◽

10.1016/j.ygyno.2015.01.231 ◽

2015 ◽

Vol 137 ◽

pp. 93-94

Author(s):

C.H. Watson ◽

M. Ulm ◽

T. Tillmanns ◽

M.E. Reed ◽

K.M. Reed

Keyword(s):

Serous Carcinoma ◽

Uterine Papillary Serous Carcinoma ◽

Stage Ia ◽

Papillary Serous Carcinoma ◽

Single Modality

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Characterization of the molecular differences between ovarian endometrioid carcinoma and ovarian serous carcinoma

The Journal of Pathology ◽

10.1002/path.2659 ◽

2009 ◽

Vol 220 (3) ◽

pp. 392-400 ◽

Cited By ~ 46

Author(s):

Jason Madore ◽

Fengge Ren ◽

Ali Filali-Mouhim ◽

Lilia Sanchez ◽

Martin Köbel ◽

...

Keyword(s):

Serous Carcinoma ◽

Endometrioid Carcinoma ◽

Ovarian Serous Carcinoma

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A comparison of adjuvant therapy approaches for patients with early-stage uterine serous carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.5517 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 5517-5517

Author(s):

Katherine Kurnit ◽

Silvana Pedra Nobre ◽

Bryan M. Fellman ◽

David A Iglesias ◽

Kristina Lindemann ◽

...

Keyword(s):

Adjuvant Therapy ◽

Adjuvant Treatment ◽

Early Stage ◽

Myometrial Invasion ◽

Figo Stage ◽

Serous Carcinoma ◽

Stage Ia ◽

Multivariable Analyses ◽

Uterine Serous Carcinoma

5517 Background: Uterine serous carcinoma is a less common subtype of endometrial cancer that is associated with poorer survival. The optimal post-operative adjuvant treatment strategy for these patients remains uncertain. Methods: This multi-institutional, retrospective cohort study evaluated patients with early stage uterine serous carcinoma. Patients with FIGO Stage IA-II disease after surgery, whose tumors had serous or mixed serous/non-serous histology were included. Patients with carcinosarcoma were excluded. Clinical data were abstracted from local medical records. Summary statistics, Fisher’s exact, and Kruskal-Wallis tests were used to analyze demographic and clinical characteristics. Univariable and multivariable analyses were performed for recurrence-free survival (RFS) and overall survival (OS). Results: 634 patients were included. 77% of patients had Stage IA disease, 42% showed no myometrial invasion. The majority had pure serous histology (72%) and LVSI (76%). Adjuvant treatment varied: 12% received no adjuvant therapy, 7% had chemotherapy alone, 51% had cuff brachytherapy, 12% had cuff brachytherapy with chemotherapy (cuff/chemo), and 19% underwent pelvic radiation (EBRT). Complete RFS and OS data were available for 607 and 609 patients, respectively, and the median follow-up time was 58 months. As compared with patients who received no adjuvant therapy, patients who received cuff or cuff/chemo had improved RFS (cuff: HR 0.70, p = 0.02; cuff/chemo HR 0.53, p = 0.01) and OS (cuff HR 0.56, p = 0.001; cuff/chemo HR 0.48, p = 0.01). In a direct comparison, patients with cuff/chemo had better RFS and OS than those with chemotherapy alone (RFS HR 0.52, p = 0.03; OS HR 0.50, p = 0.05). There were no differences in RFS or OS for women who received chemotherapy alone or EBRT. Improved survival with cuff and cuff/chemo persisted on multivariable analyses (included age, stage, LVSI, adjuvant therapy type); additionally, EBRT was also associated with improved OS. In analyses limited to patients without myometrial invasion, patients with cuff or cuff/chemo had improved RFS and OS compared with observation alone. Conclusions: The use of adjuvant cuff brachytherapy with and without chemotherapy was associated with improved RFS and OS in patients with early stage uterine serous carcinoma.

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Fertility Preserved Hysteroscopic Approach for the Treatment of Stage Ia Endometrioid Carcinoma

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001109 ◽

2017 ◽

Vol 27 (9) ◽

pp. 1919-1925 ◽

Cited By ~ 4

Author(s):

Fangfang Wang ◽

Aijun Yu ◽

Haichao Xu ◽

Xiaojing Zhang ◽

Li Li ◽

...

Keyword(s):

Polycystic Ovary ◽

Young Patients ◽

Uterine Fibroids ◽

Immunohistochemical Analysis ◽

Radical Resection ◽

Peritoneal Cytology ◽

Endometrioid Carcinoma ◽

Hysteroscopic Surgery ◽

Gynecology And Obstetrics ◽

Stage Ia

ObjectiveThis study aims to explore the feasibility of a hysteroscopic procedure combined with progestin therapy in young patients with stage Ia endometrioid carcinoma (EC) to avoid sterilization.Materials and MethodsEleven young women with stage Ia EC (International Federation of Gynecology and Obstetrics grade 1) who were treated with a hysteroscopic approach combined with progestin from July 2004 to June 2016 were retrospectively analyzed and followed up to monitor their general recovery and pregnancy outcome.ResultsThe patients' median age was 27.3 years (range, 25–39 years). Comorbidities consisted of primary infertility in 8 patients, polycystic ovary syndrome in 4, uterine fibroids in 2, and diabetes in 1. The results of immunohistochemical analysis were positive for all estrogen and progestin receptors. After treatment, 9 patients attained complete remission, and 2 patients achieved partial remission. The results of peritoneal cytology in 4 patients were negative. As of this writing, 6 of the 11 patients have given birth to 7 infants, and 1 patient had an ectopic pregnancy. Two patients ultimately underwent radical resection. The average follow-up time was 82.3 months (range, 15 to 152 months), and all patients remain disease-free.ConclusionsHysteroscopic surgery combined with progestin treatment for stage Ia EC in young patients to avoid sterilization was practical and may represent a new option for patients with stage Ia EC who wish to preserve their fertility.

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Analysis of Prediagnostic Metabolic Profiles of Endometrial Carcinoma Patients in the Obese Population

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz112.026 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S13-S14

Author(s):

X I Zhang ◽

Amy Fox ◽

Kathleen Whitney

Keyword(s):

Endometrial Carcinoma ◽

Cancer Diagnosis ◽

Serous Carcinoma ◽

Morbidly Obese ◽

Metabolic Profiles ◽

Endometrioid Carcinoma ◽

Obese Population ◽

Hba1c Levels

Abstract Endometrial carcinoma has been traditionally divided into type 1 and type 2 carcinomas. Excess estrogen is believed to be the pathologic mechanism of type 1 carcinoma. The WHO Classification of Tumors of Female Reproductive Organs lists obesity as a risk factor for type 1 endometrial carcinoma. On the contrary, type 2 carcinoma is generally not associated with estrogen or obesity. Endometrial endometrioid carcinoma is the most common type 1 carcinoma. Endometrial serous carcinoma is a typical type 2 carcinoma. In our community, with a high prevalence of obesity, we investigated whether serous carcinoma, a type 2 carcinoma, could also occur in the obese population, and whether there are identifiable metabolic differences between endometrioid carcinoma patients and serous carcinoma patients in the obese population prior to cancer diagnosis, which might provide clues to the different pathogenesis of the two types of carcinoma. Two cohorts of postmenopausal patients with serous carcinoma or endometrioid carcinoma between 2006 and 2016 were established. Then each cohort was subdivided into four categories based on patients’ average BMI (within 5 years before cancer diagnosis): nonobese (<30), moderately obese (30-35), severely obese (35-40), and morbidly obese (>40). Patients’ average triglycerides, HDL, blood pressures, and HbA1c levels (within 5 years before cancer diagnosis) were obtained. In total, 304 patients were in the endometrioid carcinoma cohort, while 135 patients were in the serous carcinoma cohort. In the morbidly obese category (BMI >40), serous carcinoma patients had significantly lower triglycerides and HbA1c levels than endometrioid carcinoma patients while their BMIs were comparable. For HDL and systolic and diastolic blood pressures, no significant difference was observed between the two groups. In each of the other BMI categories, serous carcinoma patients also had lower triglycerides and HbA1c levels than endometrioid carcinoma patients. In the serous carcinoma patient cohort, there was a moderately negative correlation between average BMI and triglycerides/HbA1c levels, with a Pearson’s correlation coefficient of –0.25 for triglycerides level and –0.19 for HbA1c level. On the contrary, there was no correlation between average BMI and triglycerides/HbA1c levels in the endometrioid carcinoma patient cohort (Pearson’s coefficient close to 0). In summary, the serous carcinoma patients in the obese population lacked the metabolic profiles generally associated with high BMI. These findings show that there are identifiable prediagnostic metabolic differences between endometrioid carcinoma patients and serous carcinoma patients. The metabolic differences between the two groups in each BMI category suggest that BMI should be combined with metabolic markers, rather than used alone, in the evaluation of risk factors for endometrial carcinoma. Future epidemiologic and experimental studies focusing on the association between metabolic syndrome and endometrial carcinoma should separate different histologic subtypes of endometrial carcinoma in the study design due to their distinct metabolic profiles.

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