title: The impact of tumor grade on survival end points and patterns of recurrence of 949 patients with early-stage endometrioid carcinoma: a single institution study.
abstract: OBJECTIVE
  This study aimed to determine the impact of tumor grade on patterns of recurrence and survival end points in patients with endometrioid carcinoma 2009 International Federation of Gynecology and Obstetrics stages I-II.
  
  
  METHODS
  We identified 949 patients who underwent hysterectomy between 1988 and 2011. Patients were divided into 3 groups based on tumor grade. Kaplan-Meier plots were generated for each group for recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS).
  
  
  RESULTS
  Median follow-up was 52 months. Median age was 60 years. All patients underwent total abdominal hysterectomy and salpingo-oophorectomy. Eighty percent of patients underwent lymph node dissection, 83% had peritoneal cytology. There were 76 (8%) patients who developed tumor recurrence. Tumor recurrence rates were significantly higher in patients with grade 3 tumors compared to grade 1 (P = 0.006). Additionally, patients with grade 3 tumors developed significantly more frequent distant metastases compared to patients with grade 1 (P = 0.002). Five-year RFS for the patients with grade 1, 2, and 3 were 95%, 82%, and 68%, respectively (P = <0.001). Five-year DSS was 99%, 93%, and 79%, respectively (P = <0.001). Five-year OS was 89%, 84%, and 63%, respectively (P = <0.001). Lymphovascular space involvement and grade were significant independent predictors of RFS and DSS. For OS age, lymphovascular space involvement, grade, and body mass index were significant predictors.
  
  
  CONCLUSIONS
  International Federation of Gynecology and Obstetrics grade is a strong predictor of clinical survival end points in women with early-stage endometrioid carcinoma. The pattern of recurrence in patients with grade 3 tumors is mainly distant rather than locoregional. Further studies incorporating systemic therapy in the adjuvant settings in these patients are warranted.
authors.affiliation: *Department of Radiation Oncology, †Department of Pathology, ‡Public Health Science, and §Division of Gynecologic Oncology, Department of Women's Health Services, Henry Ford Hospital, Detroit, MI.
authors.forename: Omar H
authors.initials: OH
authors.lastname: Gayar
authors.forename: Suketu
authors.initials: S
authors.lastname: Patel
authors.forename: Daniel
authors.initials: D
authors.lastname: Schultz
authors.forename: Meredith
authors.initials: M
authors.lastname: Mahan
authors.forename: Nabila
authors.initials: N
authors.lastname: Rasool
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elshaikh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000401:mortality / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D005836:Genitalia, Female / Q000473:pathology*; D006801:Humans; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D012189:Retrospective Studies