title: Comparative outcomes assessment of uterine grade 3 endometrioid, serous, and clear cell carcinomas.
abstract: OBJECTIVE
  The objective of this study is to assess effects of clinicopathologic risk factors and contemporary therapeutic interventions on high-risk uterine epithelial carcinoma outcomes.
  
  
  METHODS
  Patient-, disease-, and treatment-specific variables were annotated. Survival was estimated via the Kaplan-Meier method. Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratios.
  
  
  RESULTS
  From 1999 through 2008, therapy with curative intent was initiated for 119 grade 3 endometrioid (G3EC), 211 serous (USC), and 40 clear cell (CCC) carcinomas. Although clinicopathologic risk factors varied among the histologic subtypes, overall survival (OS) did not differ statistically between subtypes (P=.10) or in stage-for-stage comparative analyses (stage I/II, P=.45; stage III, P=.46; stage IV, P=.65). The 5-year cause-specific survival in stage I/II was 84.8%, 89.8%, and 83.9% for G3EC, USC, and CCC, respectively; multivariable modeling identified lymphovascular space involvement (LVSI) as the only independent prognostic factor (P=.02). For stage III, 5-year OS was 49.2% and 40.0% for G3EC and USC, respectively; multivariable modeling identified age (P<.001), LVSI (P<.001), unresectable nodal disease (P=.03), and regional radiotherapy (P=.01) as independent prognostic factors. For stage IV, 5-year OS was 8.7% and 12.1% for G3EC and USC, respectively; multivariable modeling identified LVSI (P=.002), cervical stromal invasion (P=.02), and adjuvant chemotherapy (P=.02) but not residual disease as independent prognostic factors.
  
  
  CONCLUSIONS
  When controlled for disease stage, outcomes did not differ among high-risk histologic subtypes. LVSI was a significant adverse prognostic factor within all stages. The lack of improved outcomes with contemporary therapy suggests that more innovative therapeutic approaches should be given higher priority.
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Tina A
authors.initials: TA
authors.lastname: Ayeni
authors.forename: Jamie N
authors.initials: JN
authors.lastname: Bakkum-Gamez
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.forename: Michaela E
authors.initials: ME
authors.lastname: McGree
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
authors.forename: Gary L
authors.initials: GL
authors.lastname: Keeney
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Long
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D017239:Paclitaxel / Q000008:administration & dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*
chemical_list: D009944:Organoplatinum Compounds; D004317:Doxorubicin; D017239:Paclitaxel