Risk factor analysis of recurrence in low-grade endometrial adenocarcinoma.
Prognosis of endometrial adenocarcinoma is favorable; however, the risk of recurrence ranges from 7% to 13%. Recurrence has been related to age, tumor type, International Federation of Gynecology and Obstetrics grade, depth of invasion, and lymphovascular invasion (LVI); however, morphologic features that would predict the site of recurrence have not been established. In this multi-institutional study, we reviewed 589 patients with International Federation of Gynecology and Obstetrics grades 1 or 2 endometrial adenocarcinoma, endometrioid type. Cox proportional hazard analysis was used to identify univariate and multivariate risk factors for recurrence and survival. Univariate analysis revealed features of tumors that recurred only in the vagina: low nuclear grade; superficial myoinvasion; minimal to no LVI; and minimal myoinvasion with microcystic, elongated, and fragmented (MELF) pattern; low nuclear grade and superficial myoinvasion persisted on multivariate analysis. Features of tumors that recurred at other sites included large size, deep myoinvasion, tumor necrosis, 1 or more LVI foci, LVI foci distant/deeper than invasive tumor front, MELF myoinvasion pattern, lower uterine segment and cervical stromal involvement, pelvic and/or paraaortic lymph node metastases at presentation, and higher grade of tumor in the metastatic foci, whereas increased percentage of solid component and lower percentage of mucinous features were marginally associated. Tumors with recurrences only in vagina had different features than tumors that recurred at other sites. The presence of tumor necrosis, MELF foci at the invasive tumor front, and the percentage of solid component and mucinous features could be helpful in grading endometrioid adenocarcinomas, if a 2-tier rather than a 3-tier grading system is accepted in the future.
Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, 44195. Electronic address: romaa@ccf.org.
Andres A
AA
Roma
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio, 44195.
Lisa A
LA
Rybicki
Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, 77030.
Denise
D
Barbuto
Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048.
Elizabeth
E
Euscher
Department of Pathology, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada.
Bojana
B
Djordjevic
Department of Pathology and Laboratory Medicine, Pennsylvania State University, Hershey, PA, 17033.
Elizabeth
E
Frauenhoffer
Department of Pathology, Korea University Anam Hospital, Seoul, 136-705, Republic of Korea.
Insun
I
Kim
Department of Pathology, Cheil General Hospital, Dankook University, Seoul, 100-450, Republic of Korea.
Sung Ran
SR
Hong
Instituto Nacional de Cancerologia, C.P. 14080, Mexico, DF, Mexico.
Delia
D
Montiel
Department of Pathology, Wayne State University, Detroit, MI, 48201.
Rouba
R
Ali-Fehmi
Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048.
Anais
A
Malpica
Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, 77030; Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048.
Elvio G
EG
Silva
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult
Endometrial adenocarcinoma; Endometrioid; Low-grade; Lymph node metastasis; Myometrial invasion; Recurrence