Çetin ÇELİK, Serra AKAR, Ismail HARMANKAYA

Prognostic significance of tumor grade in early-stage endometrioid endometrial cancer

Aim: Although tumor grade has no impact on endometrial cancer stage, it carries prognostic and therapeutic importance. Surgicalmanagement and adjuvant treatment following surgery in certain patients depends on a number of factors including tumor grade.Although grade 3 tumors are included in the high-intermediate risk group, there are data demonstrating that there is a slight differencein survival between patients with grade 1 and 2 tumors in early-stage disease. In this study, we aimed to investigate the associationof grade with clinicopathological characteristics, recurrence-free and disease-specific survival in patients treated at our clinic anddiagnosed with endometrioid endometrial cancer.Material and Methods: 279 patients with early FIGO Stage endometrioid endometrial cancer treated between 2009-2018 in aUniversity hospital were included in the study. The associations between tumor grade with stage, lymphovascular space invasion(LVSI), myometrial invasion, tumor size, and survival were analyzed.Results: LVSI, ≥50% myometrial invasion, advanced stage and > 2 cm tumor size were significantly higher in grade 3 tumors comparedto patients with grade 1 tumors. Recurrence-free and disease-specific survival were significantly lower in patients with grade 2 and3 tumors compared to patients with grade 1 tumors. In multivariate analysis of RFS and DSS, tumor grade, LVSI and stage wereindependent prognostic factors.Conclusion: According to this study, grade 2 tumors may not differ significantly from grade 3 tumors in terms of survival. Therefore,due to the potential adverse prognosis associated with grade 2 and 3 tumors, vigilance for recurrence is warranted.

PDF

___

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7.
2. Surveillance, Epidemiology, and End Results (SEER) Program stat fact sheets: endometrial cancer. Available at: http://seer.cancer.gov/statfacts/html/corp.html.
3. Shepherd JH. Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol 1989;96:889–92.
4. Wortman BG, Creutzberg CL, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LCHW et al. PORTEC Study Group. Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy. Br J Cancer 2018;119:1067-74.
5. Soslow RA, Tornos C, Park KJ et al. Endometrial Carcinoma Diagnosis: Use of FIGO Grading and Genomic Subcategories in Clinical Practice: Recommendations of the International Society of Gynecological Pathologists.Int J Gynecol Pathol 2019;38:64-74.
6. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 2009; 105:103.
7. Han KH, Kim HS, Lee M, et al. Prognostic factors for tumor recurrence in endometrioid endometrial cancer stages IA and IB. Medicine (Baltimore) 2017;96:6976.
8. Esselen KM, Boruta DM, del Carmen M, et al. Defining prognostic variables in recurrent endometrioid endometrial cancer: a 15-year single-institution review. Int J Gynecol Cancer 2011;21:1078–83.
9. Cusano E, Myers V, Samant R, et al. Prognostic Significance of Lymphovascular Space Invasion in the Absence of Lymph Node Metastases in Early-Stage Endometrial Cancer.Int J Gynecol Cancer 2018;28:890-94.
10. Turkmen O, Tasci T, Basaran D, et al. Stage IB Endometrioid Type Endometrial Cancer: The Role of Lymphadenectomy and Adjuvant Radiation Therapy. Gynecol Obstet Reprod Med 2018;24:156-61.
11. Suarez Mora A, Horne Z, Taylor S, et al. Impact of histological grade on oncologic outcomes in clinical stage I patients with endometrial carcinoma patients after definitive primary radiation therapy. Int J Gynecol Cancer. 2019;pii: ijgc-2018-000124.
12. Gulseren V, Kocaer M, Ozdemir IA, et al. Association Between Maximum Standardize Uptake Value and Prognostic Factors at Endometrioid Type Endometrial Carcinoma. Gynecol Obstet Reprod Med 2019;1-6.