Should grade 3 endometrioid endometrial carcinoma be considered a type 2 cancer-A clinical and pathological evaluation.
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Colleges, School and Institutes
OBJECTIVE: Endometrial cancer is classified into: Type I estrogen-dependent endometrioid adenocarcinoma, with good prognosis and type 2 non-estrogen-dependent cancer with serous or clear cell histology and poor prognosis. Grade 3 endometrioid cancers (G3 EEC), share features of type 1 and type 2 cancer and have not been classified as either. This study compares immunohistochemistry and survival in G3 EEC and type 2 cancers. METHODS: Clinicopathological data compared with immunohistochemistry and survival in 156 consecutive patients with poor prognosis cancer-G3 EEC, uterine papillary serous (UPSC) and clear cell carcinoma (CC), sarcoma, carcinosarcoma and endometrial tumors of mixed histology. 131 (84%) datasets were complete, 25 tumors comprising sarcoma, carcinosarcoma or mixed histologies were excluded. Tissue microarray constructed and tested for estrogen receptor (ER), progesterone receptor (PR), p53 and human epidermal growth factor receptor-2 (Her-2). RESULTS: There was no significant difference in the mean age for G3 EEC (n=68) and USPC+CC (n=38), (68.01 and 67.08 respectively, p=0.697) or stage at diagnosis (p=0.384). For ER, PR, p53 and Her-2, there was no significant difference in marker positivity between G3 EEC and UPSC+CC (p=0.612, 0.132, 0.16 and 0.132 respectively). With a mean follow-up time 148months Disease specific and recurrence-free survival between G3 EEC and USPC+CC was similar (p=0.842 and 0.863). CONCLUSION: G3 EEC and UPSC+CC share similar clinical, immunohistochemistry and poor survival. G3 EEC is better characterised as type 2 cancer and should be treated with similar adjuvant therapy to UPSC/CC.
This paper was the first to demonstrate the continuum between grade 3 endometrioid cancer and uterine serous cancer – which are treated very differently. This concept has since been confirmed by Tumour cancer genomics analysis work on uterine cancer ( Nature May 2013) and highlighted in JCO Jan2014 in the article Clinical Cancer Advances 2013: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology. Citations 41
|Publication status||Published - 22 Aug 2011|
- grade 3, endometrioid carcinoma, type 2 cancer