Alpaslan KABAN, Samet TOPUZ

Survival outcomes in patients with undifferentiated endometrial carcinoma

Objective: The aim of this study was to investigate the clinicopathological features and survival of patients with undifferentiated endometrial carcinoma (UEC). Methods: Patients who were operated between 2006 and 2014 for endometrial cancer (EC) in the same center were retrospectively reviewed from the clinical archive. Data were obtained from patient files. Survival curves and rates were calculated using the Kaplan-Meier method, and differences in survival were evaluated using the Log-Rank test. Results: In this study, 774 patients with EC were screened. According to the pathology report, 14 (1.8%) had undifferentiated type histology. The mean age, parity and body mass index (BMI) of the patients were 58.6 year (range 40-73); 3.28 (range 0-6) and 32.1 kg/m2 (range 22.8-41.7), respectively. Of the patients, 64% (n=9) had deep myometrial invasion, 93% (n=13) had lymphovascular space invasion, and 57% (n=8) had cervical involvement. Tumor size was greater than 5 cm in 64% (n=9) of the patients. Thirty five percent (n=5) of the patients were stage 1A, 21% (n=3) were stage 1B, 14% (n=2) were stage 2, 14% were stage 3C, and 14% were stage 4. As adjuvant therapy, 21% (n=3) of the patients received chemotherapy only, 14% (n=2) received radiotherapy only, and 57% (n=8) received chemotherapy and radiotherapy together. The mean follow-up duration was 36 months (range 4-104). In this period, survival rates were 77% for early-stage (FIGO 1-2) and 0% for advanced-stage (FIGO 3-4). The mean survival duration was 81 months in the early stage; 6.8 months in advanced stage (Log Rank test P value= 0.001). Conclusion: According to this study, UEC is highly associated with pathological poor prognostic factors such as deep myometrial invasion, lymphovascular space invasion, cervical involvement and large tumor size. Patients with advanced stage do not have the chance to survive. Long-term survival is possible if the diagnosis and treatment of the disease is achieved while the tumor is limited to the uterus.

Andiferansiye endometrial karsinomlu hastalarda sağ kalım sonuçları

Amaç: Çalışmanın amacı, andiferansiye tip histolojideki endometrial karsinomlu (UEC) hastaların klinikopatolojik ve sağkalım özelliklerini incelemektir. Yöntemler: Aynı merkezde 2006 ve 2014 yılları arasında endometrial kanser (EC) nedeniyle opere edilen hastalar, klinik arşivden retrospektif olarak incelendi. Veriler hasta dosyalarından elde edildi. Sağ kalım süreleri Kaplan-Meier yöntemi kullanılarak hesaplandı ve sağ kalımdaki farklılıklar Log-Rank testi kullanılarak değerlendirildi. Bulgular: Bu çalışmada, 774 EC hastası tarandı. Patoloji raporuna göre 14’ünde (%1,8) UEC tip histoloji saptandı. Hastaların ortalama yaş, parite ve vücut kitle indeksi (VKİ) sırayla 58.6 (40-73), 3.28 (0-6) ve 32.1 kg / m2 (22.8-41.7) bulundu. Hastaların %64'ünde (n=9) derin miyometriyal invazyon, %93'ünde (n=13) lenfovasküler alan invazyonu, %57'sinde (n=8) servikal tutulum vardı. Tümör boyutu hastaların%64'ünde (n=9) 5 cm'den büyüktü. Hastaların% 35'i(n=5) evre 1A,%21'i (n=3) evre 1B, %14'ü (n=2) evre 2, %14'ü (n=2) evre 3C ve %14'ü (n=2) evre 4 idi. Adjuvant tedavi olarak hastaların %21'i (n=3) sadece kemoterapi aldı, %14'ü (n=2) sadece radyoterapi aldı ve %57'si(n=8) kemoterapi ve radyoterapi aldı. Ortalama takip süresi 36 aydı (4-104). Bu dönemde sağ kalım oranları erken evre için %77 (FIGO 1-2) ve ileri evre için %0 idi (Şekil 3-4). Ortalama hayatta kalma süresi erken evrede 81 ay,; ileri evrede 6.8 ay bulundu (Log Rank testi P değeri = 0.001). Sonuç: Bu çalışmaya göre, UEC derin miyometriyal invazyon, lenfovasküler alan invazyonu, servikal tutulum ve büyük tümör boyutu gibi patolojik kötü prognostik faktörlerle ilişkilidir. İleri evreli hastalar hayatta kalma şansına sahip değildir. Uzun süreli sağ kalım, tümör uterusa sınırlıyken hastalığın teşhisi ve tedavisi gerçekleştirilirse mümkündür.

PDF

___

Acharya S, Hensley ML, Montag AC, Fleming GF. Rare uterine cancers. Vol. 6, Lancet Oncology. 2005. p. 961– 71.

Ramalingam P, Masand RP, Euscher ED, Malpica A. Undifferentiated Carcinoma of the Endometrium: An Expanded Immunohistochemical Analysis Including PAX-8 and Basal-Like Carcinoma Surrogate Markers. Int J Gynecol Pathol. 2016; 35: 410-8.

Altrabulsi B, Malpica A, Deavers MT, et all. Undifferentiated carcinoma of the endometrium. Am J Surg Pathol. 2005; 29: 1316–21.

Silva EG, Deavers MT, Malpica A. Undifferentiated carcinoma of the endometrium: A review. Pathology. 2007; 39: 134–8.

Abeler VM, Nesland JM, Kjell E. Kjorstad. Undifferentiated carcinoma of the endometrium. A histopathologic and clinical study of 31 cases. Cancer. 1991; 68: 98–105.

Garg K, Soslow RA. Endometrial undifferentiated carcinomas. Pathology Case Reviews. 2011.

Espinosa I, Lee CH, D'Angelo E, Palacios J, Prat J. Undifferentiated and Dedifferentiated Endometrial Carcinomas With POLE Exonuclease Domain Mutations Have a Favorable Prognosis. Am J Surg Pathol. 2017 Aug; 41: 1121-8.

Eble, John N., Fattaneh A. Tavassoli, and Peter Devilee, eds. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. Iarc, 2003.

Tafe LJ, Garg K, Chew I, Tornos C, Soslow RA. Endometrial and ovarian carcinomas with undifferentiated components: Clinically aggressive and frequently underrecognized neoplasms. Mod Pathol. 2010; 23: 781–9.

Koh WJ, Abu-Rustum NR, Bean S, et al. Uterine Neoplasms, Version 1.2018: Clinical practice guidelines in oncology. JNCCN Journal of the National Comprehensive Cancer Network. 2018.

Markman M. General principles: chemotherapy. In: Berek JS HN, editor. Practical Gynaecologic Oncology. Lipincott Williams and Wilkins; 2004. p. 91.

Hayashi M, Ueda Y, Takimoto T, Ohkura T. Undifferentiated endometrial carcinoma of the uterus: marked effect of chemotherapy with tetrahydropyranyl-adriamycin, paclitaxel, and carboplatin. Int J Gynecol Cancer. 2004; 14: 388-94