title: Risk factors for recurrence and prognosis of low-grade endometrial adenocarcinoma; vaginal versus other sites.
abstract: Endometrial adenocarcinoma is the most common gynecologic cancer in the United States. The prognosis is generally favorable, however, a significant number of patients do develop local or distant recurrence. The most common site of recurrence is vaginal. Our aim was to better characterize patients with vaginal recurrence of low-grade endometrioid adenocarcinoma with respect to associated tumor parameters and clinical outcome. We compiled 255 cases of low-grade (FIGO Grade I or II) endometrioid adenocarcinoma on hysterectomy specimens with lymph node dissection. A total of 113 cases with positive lymph nodes or recurrent disease were included in our study group. Seventy-three cases (13 Grade 1, 60 Grade 2) developed extravaginal recurrence and 40 cases (7 Grade 1, 33 Grade 2) developed vaginal recurrence. We evaluated numerous tumor parameters including: percentage myoinvasion, presence of microcystic, elongated, and fragmented pattern of myoinvasion, lymphovascular space invasion, and cervical involvement. Clinical follow-up showed that 30% (34/113) of all patients with recurrent disease died as a result of their disease during our follow-up period, including 31 (42.5%) with extravaginal recurrence and 3 (7.5%) with primary vaginal recurrence (P=0.001). The 3 patients with vaginal recurrence developed subsequent extravaginal recurrence before death. Vaginal recurrence patients show increased cervical involvement by tumor, but lack other risk factors associated with recurrent disease at other sites. There were no deaths among patients with isolated vaginal recurrence, suggesting that vaginal recurrence is not a marker of aggressive tumor biology.
authors.affiliation: Departments of Pathology (E.J.M., D.A.B., E.G.S.) and Laboratory Medicine Gynecologic Oncology (C.W.), Cedars-Sinai Medical Center, Los Angeles, California Lurie Center for Autism (K.S.), Massachusetts General Hospital for Children, Boston, Massachusetts Department of Pathology (E.D.E., A.M., E.G.S.) and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas Department of Pathology (A.A.R.) and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio Department of Pathology (R.A.-F.) and Laboratory Medicine, Wayne State University, Detroit, Michigan Department of Pathology (E.E.F.), PennState M.S. Hershey Medical Center, Hershey, Pennsylvania Department of Pathology (D.P.M.) and Laboratory Medicine, Instituto Nacional de Cancerologia, Mexico DF, Mexico Department of Pathology (B.D.) and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada Department of Pathology (I.K.), Korea University Anam Hospital Department of Pathology (S.R.H.), Kwandong University Cheil General Hospital and Women's Healthcare Center, Seoul, Korea.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Moschiano
authors.forename: Denise A
authors.initials: DA
authors.lastname: Barbuto
authors.forename: Christine
authors.initials: C
authors.lastname: Walsh
authors.forename: Kanwaljit
authors.initials: K
authors.lastname: Singh
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Euscher
authors.forename: Andres A
authors.initials: AA
authors.lastname: Roma
authors.forename: Rouba
authors.initials: R
authors.lastname: Ali-Fehmi
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Frauenhoffer
authors.forename: Delia P
authors.initials: DP
authors.lastname: Montiel
authors.forename: Insun
authors.initials: I
authors.lastname: Kim
authors.forename: Bojana
authors.initials: B
authors.lastname: Djordjevic
authors.forename: Anais
authors.initials: A
authors.lastname: Malpica
authors.forename: Sung Ran
authors.initials: SR
authors.lastname: Hong
authors.forename: Elvio G
authors.initials: EG
authors.lastname: Silva
mesh_terms: D000328:Adult; D000368:Aged; D018269:Carcinoma, Endometrioid / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000473:pathology*; D014621:Vagina / Q000473:pathology; D014625:Vaginal Neoplasms / Q000401:mortality / Q000473:pathology*