Clinical stage i endometrial cancer: Prognostic factors for local control and distant metastasis and implications of the new figo surgical staging system

Grigsby, Perry W.; Pérez, Carlos A.; Kuten, Abraham; Simpson, Joseph R.; Garcia, Delia M.; Camel, H. Marvin; Kao, Ming‐Shian; Galakatos, Andrew E.

doi:10.1016/0360-3016(92)90786-h

Cited by 116 publications

(59 citation statements)

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“…Based on studies that found that positive cytology is an independent adverse prognostic factor (Harouny et al, 1988;Mazurka et al, 1988;Brewington et al, 1989;Turner et al, 1989;Sutton, 1990;Morrow et al, 1991;Grigsby et al, 1992;Kadar et al, 1994;Descamps et al, 1997;Kashimura et al, 1997;Obermair et al, 2001), postoperative adjuvant therapy was recommended for patients with positive peritoneal cytology. Progestins, whole abdominal external radiation, intraperitoneal radioactive chromic phosphate ( 32 P), and multiagent chemotherapy have been proposed.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of positive peritoneal cytology in endometrial carcinoma confined to the uterus

et al. 2003

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A retrospective analysis was performed to evaluate the prognostic significance of peritoneal cytology in patients with endometrial carcinoma limited to the uterus. A total of 280 patients with surgically staged endometrial carcinoma that was histologically confined to the uterus were examined clinicopathologically. The median length of follow-up was 62 (range, 12 -135) months. All patients underwent hysterectomy and salpingo-oophorectomy with selective lymphadenectomy, and only three patients received adjuvant postoperative therapy. No preoperative adjuvant therapy was employed. In all, 48 patients (17%) had positive peritoneal cytology. The 5-year survival rate among patients with positive or negative peritoneal cytology was 91 or 95%, respectively, showing no significant difference (log-rank, P ¼ 0.42). The disease-free survival rate at 36 months was 90% among patients with positive cytology, compared with that of 94% among patients with negative cytology, and the difference was not significant (log-rank, P ¼ 0.52). Multivariate proportional hazards model revealed only histologic grade to be an independent prognostic factor of survival (P ¼ 0.0003, 95% CI 3.02 -40.27) among the factors analysed (age, peritoneal cytology, and depth of myometrial invasion). Multivariate analysis revealed that histologic grade (P ¼ 0.02, 95% CI 1.21 -9.92) was also the only independent prognostic factor of disease-free survival. We concluded that the presence of positive peritoneal cytology is not an independent prognostic factor in patients with endometrial carcinoma confined to the uterus, and adjuvant therapy does not appear to be beneficial in these patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic significance of positive peritoneal cytology in endometrial carcinoma confined to the uterus

et al. 2003

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“…In three-fourths of cases of this disease, the tumour is clinically confined to the uterus at the time of diagnosis, and most patients with early-staged disease achieve a favourable clinical outcome with surgery alone (Morrow et al, 1991;Grigsby et al, 1992). However, a significant number of patients with early-staged disease develop localised recurrence or distant metastases, and the patients with recurrence or advanced disease show a poor outcome (Lotocki et al, 1983).…”

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“…However, a significant number of patients with early-staged disease develop localised recurrence or distant metastases, and the patients with recurrence or advanced disease show a poor outcome (Lotocki et al, 1983). Several clinicopathological parameters are currently used for the classification of risks for relapse and death, such as surgical stage, histological type, grade, depth of myometrial invasion, cervical stromal invasion, lymph node metastasis, lymph-vascular involvement, and peritoneal cytology (Morrow et al, 1991;Grigsby et al, 1992). For patients belonging to high or intermediate risk groups defined by these parameters, either postoperative adjuvant radiation therapy, or chemotherapy has been used (Creutzberg et al, 2000;Keys et al, 2004;Sagae et al, 2005).…”

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Indoleamine 2,3-dioxygenase is a novel prognostic indicator for endometrial cancer

et al. 2006

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Indoleamine 2,3-dioxygenase (IDO) is a tryptophan-catabolising enzyme inducing immune tolerance. The present study aimed to investigate IDO expression and its prognostic significance in endometrial cancer. Indoleamine 2,3-dioxygenase expression in endometrial cancer tissues (n ¼ 80) was immunohistochemically scored as four groups (IDOÀ, 1 þ , 2 þ , and 3 þ ). The high IDO expression (IDO2 þ or 3 þ ) in tumour cells was found in 37 (46.3%) of the 80 cases, and was positively correlated with surgical stage, myometrial invasion, lymph-vascular space involvement, and lymph node metastasis, but not with the histological grade. Patients with high IDO expression had significantly impaired overall survival and progression-free survival (PFS) (P ¼ 0.002 and P ¼ 0.001, respectively) compared to patients with no or weak expression of IDO (IDOÀ or 1 þ ). The 5-year PFS for IDOÀ/1 þ , 2 þ , and 3 þ were 97.7, 72.9, and 36.4%, respectively. Even in patients with early-stage disease (International Federation of Gynecology and Obstetrics I/II, n ¼ 64), the PFS for IDO2 þ /3 þ was significantly poor (P ¼ 0.001) compared to that for IDOÀ/1 þ . On multivariate analysis, IDO expression was an independent prognostic factor for PFS (P ¼ 0.020). These results indicated that the high IDO expression was involved in the progression of endometrial cancer and correlated with the impaired clinical outcome, suggesting that IDO is a novel and reliable prognostic indicator for endometrial cancer.

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“…5,6 In general, older patients with endometrial carcinoma tend to have deep myometrial invasion, poorly differentiated histology, or extrauterine spread. 7,8 However, the negative influence of advanced age on outcome still could be demonstrated in patients who underwent full surgical staging 2 or those with well to moderately differentiated tumors. 9 Perhaps the poor outcome in some of the reports in the literature could be attributed to the less aggressive adjuvant therapy (i.e., radiation therapy), offered to elderly patients.…”

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Is endometrial carcinoma intrinsically more aggressive in elderly patients?

Alektiar

Venkatraman

Abu‐Rustum

et al. 2003

Cancer

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BACKGROUNDThe current study was conducted to determine the influence of old age (age ≥ 70 years) on outcome in a group of patients with endometrial carcinoma who were treated with simple hysterectomy followed by adjuvant radiation therapy (RT).METHODSBetween November 1987 and May 2000, 405 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage IB‐II endometrial carcinoma were treated with postoperative RT. Intravaginal RT alone was given to 77% of patients (median dose, 21grays [Gy] given in 3 fractions). Additional postoperative external beam radiation therapy (EBRT) was given to 23% of patients (median dose, 45 Gy). Eighty‐four patients were age ≥ 70 years and 321 patients were age < 70 years. The two groups were well balanced with regard to race, comprehensive surgical staging, aggressive histology, lymphovascular invasion, lower uterine segment involvement, cervical involvement, and the use of postoperative EBRT. Significantly more patients in the age ≥ 70 years group had other comorbidities such as obesity, diabetes mellitus, or hypertension (P = 0.02) and were found to have deep (> 50%) myometrial invasion (P = 0.008).RESULTSWith a median follow‐up time of 48 months, the 5‐year locoregional control (LRC), disease‐free survival (DFS), and overall survival (OS) rates were 95%, 91%, and 90% respectively. On multivariate analysis, poor LRC was found to be correlated with age ≥ 70 years (P = 0.019) and lymphovascular invasion (P = 0.001). Poor DFS was found to be correlated with age ≥ 70 years (P = 0.03), lymphovascular invasion (P = 0.01), and aggressive histology (P = 0.001). Similarly, poor OS was found to correlate with age ≥ 70 years (P = 0.001), lymphovascular invasion (P = 0.01), aggressive histology (P = 0.01), and cervical involvement (P = 0.02). The same factors that were found to correlate with OS (age ≥ 70 years, lymphovascular involvement, aggressive histology, and cervical involvement) also appeared to correlate with disease‐specific survival (P = 0.03, P = 0.008, P = 0.001, and P = 0.04, respectively). The 5‐year actuarial rates of Radiation Therapy Oncology Group late complications that were ≥ Grade 3 (gastrointestinal tract, genitourinary tract, or vagina) were 3% in both groups.CONCLUSIONSEven when treated in a similar fashion, endometrial carcinoma patients age ≥ 70 years appear to fare worse than younger patients independent of other poor prognostic factors. The rate of complications from adjuvant RT, despite a higher rate of comorbidity in elderly patients, was found to be similar in both age groups. Endometrial carcinoma appears to be intrinsically more aggressive in older patients, thus mandating further improvement in their treatment strategies. Cancer 2003. © 2003 American Cancer Society.

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Clinical stage i endometrial cancer: Prognostic factors for local control and distant metastasis and implications of the new figo surgical staging system

Cited by 116 publications

References 8 publications

Prognostic significance of positive peritoneal cytology in endometrial carcinoma confined to the uterus

Prognostic significance of positive peritoneal cytology in endometrial carcinoma confined to the uterus

Indoleamine 2,3-dioxygenase is a novel prognostic indicator for endometrial cancer

Is endometrial carcinoma intrinsically more aggressive in elderly patients?

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