Salim ERKAYA, Mehmet Mutlu MEYDANLI, Ali Levent ŞİRVAN, Hasan Onur TOPÇU, Tayfun GÜNGÖR, Murat ÖZ

Is lower uterine segment involvement a prognostic factor in endometrial cancer?

Background/aim: The purpose of this study is to investigate the prognostic significance of lower uterine segment (LUS) involvement in endometrial cancer (EC). Materials and methods: We reviewed the patients who were operated at our institution between July 2007 and March 2015 with the diagnosis of EC. Tumors localized in the corpus and involving the LUS or localized entirely in the LUS formed Group A, while tumors in the uterine corpus without LUS involvement formed Group B. Clinicopathological characteristics and survival of the patients were compared in both groups. Results: A total of 500 patients were included in the study. There were 139 patients who had tumors involving the LUS and formed Group A, while 361 patients with endometrial tumors in the uterine corpus without LUS involvement formed Group B. We did not detect a significant difference between survival of the patients in group A and group B (78 months vs. 87 months, respectively; P > 0.05). Conclusion: We found that LUS involvement was not an independent prognostic factor for poor survival, but it is associated with other poor prognostic factors such as deep myometrial invasion, uterine serosal involvement, lymphovascular space invasion, lymph node metastasis and higher FIGO grade.

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1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ. Cancer statistics, 2008. CA Cancer J Clin 2008; 58: 71-96.
2. Jacques SM, Qureshi F, Ramirez NC, Malviya VK, Lawrence WD. Tumors of the uterine isthmus: clinicopathologic features and immunohistochemical characterization of p53 expression and hormone receptors. Int J Gynecol Pathol 1997; 16: 38-44.
3. Westin SN, Lacour RA, Urbauer DL, Luthra R, Bodurka DC, Lu KH, Broaddus RR. Carcinoma of the lower uterine segment: a newly described association with Lynch syndrome. J Clin Oncol 2008; 26: 5965-5971.
4. Hachisuga T, Kaku T, Enjoji M. Carcinoma of the lower uterine segment. Clinicopathologic analysis of 12 cases. Int J Gynecol Pathol 1989; 8: 26-35.
5. Sorvari TE, Laakso L. Histochemical investigation of epithelial mucosubstances in the uterine isthmus. Obstet Gynecol 1970; 36: 76-81.
6. Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 1983; 15: 10-17.
7. Hachisuga T, Fukuda K, Iwasaka T, Hirakawa T, Kawarabayashi T, Tsuneyoshi M. Endometrioid adenocarcinomas of the uterine corpus in women younger than 50 years of age can be divided into two distinct clinical and pathologic entities based on anatomic location. Cancer 2001; 92: 2578-2584.
8. Phelan C, Montag AG, Rotmensch J, Waggoner SE, Yamada SD, Mundt AJ. Outcome and management of pathological stage I endometrial carcinoma patients with involvement of the lower uterine segment. Gynecol Oncol 2001; 83: 513-517.
9. Mayr NA, Wen BC, Benda JA, Sorosky JI, Davis CS, Fuller RW, Hussey DH. Postoperative radiation therapy in clinical stage I endometrial cancer: corpus, cervical, and lower uterine segment involvement--patterns of failure. Radiology 1995; 196: 323-328.
10. Kizer NT, Gao F, Guntupalli S, Thaker PH, Powell MA, Goodfellow PJ, Mutch DG, Zighelboim I. Lower uterine segment involvement is associated with poor outcomes in early-stage endometrioid endometrial carcinoma. Ann Surg Oncol 2011; 18: 1419-1424.
11. Doll KM, Tseng J, Denslow SA, Fader AN, Gehrig PA. Highgrade endometrial cancer: revisiting the impact of tumor size and location on outcomes. Gynecol Oncol 2014; 132: 44-49.
12. Brown AK, Madom L, Moore R, Granai CO, DiSilvestro P. The prognostic significance of lower uterine segment involvement in surgically staged endometrial cancer patients with negative nodes. Gynecol Oncol 2007; 105: 55-58.
13. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, Spiegel G, Barakat R, Pearl ML, Sharma SK. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 2009; 27: 5331- 5336.