The Significance of Adnexal Involvement in Endometrial Carcinoma

doi:10.1006/gyno.1999.5415

Gynecologic Oncology

Volume 74, Issue 1, July 1999, Pages 74-79

https://doi.org/10.1006/gyno.1999.5415 Get rights and content

Abstract

Objective. To evaluate the prognostic significance of and predictive factors for adnexal involvement (AI) in patients with endometrial carcinoma.

Methods. We retrospectively reviewed the pathological features and outcomes of endometrial carcinoma patients. The prognostic significance of AI was examined by univariate and multivariate analyses. Median follow-up was 30.7 months.

Results. Of the 382 cases reviewed, 40 (10.5%) had AI. Patients with AI had a worse 5-year disease-free (DFS) survival (73.1 vs 37.1%, P < 0.0001) than patients without AI. However, patients with AI had multiple adverse features, including high grade disease, lymphovascular invasion, and additional sites of extrauterine disease. After controlling for these factors on multivariate analysis, AI lost its prognostic significance (P = 0.56). The 12 AI patients without other extrauterine disease had a favorable outcome (5-year DFS of 70.9%). Factors predictive of AI on logistic regression were metastatic disease, positive peritoneal washings, cervical involvement, and unfavorable histology.

Conclusion. Endometrial carcinoma patients with AI have relatively poor prognoses. However, AI per se has little, if any, independent prognostic significance. The poor outcomes seen in these patients appear to result from the preponderance of other adverse pathologic factors.

References (29)

AH Wolfson et al.
The prognostic significance of surgical staging for carcinoma of the endometrium
Gynecol Oncol
(1992)
KM Greven et al.
Analysis of failure patterns in stage III endometrial carcinoma and therapeutic implications
Int J Radiat Oncol Biol Phys
(1989)
N Takeshima et al.
Ovarian metastasis in endometrial carcinoma
Gynecol Oncol
(1998)
JO Schorge et al.
The effect of postsurgical therapy on stage III endometrial carcinoma
Gynecol Oncol
(1996)
CP Morrow et al.
Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study
Gynecol Oncol
(1991)
H Cd Frick et al.
Carcinoma of the endometrium
Am J Obstet Gynecol
(1973)
WT Creasman et al.
Prognostic significance of peritoneal cytology in patients with endometrial cancer and preliminary data concerning therapy with intraperitoneal radiopharmaceuticals
Am J Obstet Gynecol
(1981)
S Sall et al.
Factors affecting survival of patients with endometrial adenocarcinoma
Am J Obstet Gynecol
(1970)
PW Grigsby et al.
Results of therapy, analysis of failures, and prognostic factors for clinical and pathologic stage III adenocarcinoma of the endometrium
Gynecol Oncol
(1987)
BF Danoff et al.
Stage III Endometrial carcinoma: Analysis of patterns of failure and therapeutic implications
Int J Radiat Oncol Biol Phys
(1980)

JE Bruckman et al.

Stage III adenocarcinoma of the endometrium: two prognostic groups

Gynecol Oncol

(1980)

RA Potish

Abdominal radiotherapy for cancer of the uterine cervix and endometrium

Int J Radiat Oncol Biol Phys

(1989)

ML Berman et al.

Prognosis and treatment of endometrial cancer

Am J Obstet Gynecol

(1980)

Gynecol Oncol

(1989)

Cited by (62)

2023 FIGO staging system for endometrial cancer: The evolution of the revolution
2024, Gynecologic Oncology
Embracing the complex and diverse nature of the heterogenous group of malignancies that are included under the umbrella of “endometrial cancer” (EC) to better align prognosis with treatment recommendations, requires a more comprehensive staging system. Our goal at the development of the new FIGO staging was to provide 1) high accuracy in the predictive prognosis for a patient with EC, which is the genuine purpose of a staging system, and 2) identification of distinct treatment relevant subgroups. Since the publication of the 2009 staging system by the International Federation of Gynecology and Obstetrics (FIGO) 14 years ago (1, 2), our understanding of the biology and natural history of EC has undergone a radical transformation. The TGCA results in 2013 (3), and the many validation reports published since then (4–9), have taught us that “EC” is composed of at least four distinct molecularly defined diseases. Strong histopathologic markers reflecting tumor biology such as lymph vascular space invasion (LVSI) were identified. Importantly, anatomical borders were shown to lose their prognostic relevance for EC patients in the presence of dominant tumor biology-markers such as molecular subtypes/LVSI (10, 11). This emphasizes the integration of these novel markers into a prognostic staging system that aims to be relevant to patients. The 2023 FIGO staging system for EC harmonizes and integrates old and new knowledge on anatomic, histopathologic, and molecular features (12). It requires a change in our perception of a staging system, from a traditional purely anatomical borders-based system to an integrated staging system integrating anatomical borders and tumor biology as pivotal prognostic factors for EC patients while providing important information for treatment decision making. Therefore, the 2023 FIGO staging system demonstrates the logical next step in the evolution of the revolution in a patient-centric staging approach.
Below, we elucidate the rationale for the FIGO 2023 endometrial cancer staging system.
Adenocarcinoma of the uterine corpus and sarcomas of the uterus
2023, DiSaia and Creasman Clinical Gynecologic Oncology
Endometrial cancer remains the only gynecologic malignancy with a rising incidence and mortality. Although diagnostic techniques have evolved modestly, the surgical management of endometrial cancer was transformed with incorporation of sentinel lymph node dissection paradigms. Furthermore, significant gains have been achieved in molecular characterization of endometrial cancer, with publication of The Cancer Genome Atlas (TCGA) endometrial and subsequent studies. Incorporation of molecular diagnostics has ushered in immunotherapy as an effective treatment strategy in select patients, with alternate targeted therapies emerging as promising options.
Ovarian metastasis risk factors in endometrial carcinoma: A systematic review and meta-analysis
2021, European Journal of Obstetrics and Gynecology and Reproductive Biology
To investigate the incidence of ovarian metastasis in endometrial carcinoma (EC) and analyze its risk factors and provide a theoretical basis for whether retention of the ovary in patients with EC.
A systematic search using synonyms of ‘ovarian cancer’ and ‘metastasis' was conducted in PubMed, Cochrane database, Embase, Google Scholar, and WOS database. Meta-analysis was performed on 7 included studies, comprising 4281 clinical-stage I-IV EC patients. Studies were assessed using the Newcastle–Ottawa Scale (NOS) criteria. Odds risks (OR) and 95% confidence intervals (CI) were calculated using an inverse variance weighted random-effects model.
The ovarian metastasis risk of EC was significantly higher for patients with myometrial invasion >1/2 (OR = 18.19, 95% CI 5.34 to 61.96 compared to myometrial invasion ≤1/2), any pelvic lymph node invasion (PLNI) (OR = 5.41, 95% CI 2.60–10.97 compared to without PLNI), G3 pathological grade (OR = 2.66, 95%CI 1.35–5.24 compared to G1-G2), non-endometrioid pathological type (OR = 6.46, 95% CI 3.25 to 12.83 compared to endometrioid), lymphatic vascular space invasion (LVSI) (OR = 6.46, 95% CI 3.25 to 12.83 compare to without LVSI), age >45 (OR = 2.01, 95% CI 0.29 to 14.11 compared to age ≤45), and cervical invasion (OR = 4.12, 95% CI 1.87 to 9.08 compared to without cervical invasion).
About 4.95% of EC patients develop ovarian metastasis. Age >45, myometrial invasion >1/2, cervical invasion, PLNI, pathological type, G3 pathological grade, and LVSI were the high-risk factors for ovarian metastasis of EC. Ovarian preservation should be carefully selected for patients with EC, and preoperative and intraoperative evaluations should be entirely performed.
ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma
2021, Radiotherapy and Oncology
Citation Excerpt :
This suggested that they were synchronous primary tumours rather than metastatic sites. Several criteria have been used in the past to distinguish between endometrial carcinoma with ovarian metastasis and synchronous primary tumours [296–297]. However, these were not easy to apply.
A European consensus conference on endometrial carcinoma was held in 2014 to produce multidisciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide.
ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (27 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2014, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 191 independent international practitioners in cancer care delivery and patient representatives.
The guidelines comprehensively cover endometrial carcinoma staging, definition of prognostic risk groups integrating molecular markers, pre- and intra-operative work-up, fertility preservation, management for early, advanced, metastatic, and recurrent disease and palliative treatment. Principles of radiotherapy and pathological evaluation are also defined.
Adenocarcinoma of the uterine corpus
2018, Clinical Gynecologic Oncology
Who benefits from chemoradiation in stage III-IVA endometrial cancer? An analysis of the National Cancer Data Base
2016, Gynecologic Oncology
Citation Excerpt :
Approximately 10% of patients present with advanced endometrial carcinoma (AEC), defined as International Federation of Gynecology and Obstetrics (FIGO) stage III–IVA disease [2,3]. Prognosis may vary according to number of extrauterine sites, presence of lymph node involvement, grade and histologic subtype [3–9]. Postoperatively, patients with AEC appear to benefit from adjuvant therapy to reduce recurrence risk [10–13].
Adjuvant therapy for advanced endometrial cancer (AEC) is not standardized. We investigated whether regional radiotherapy with chemotherapy (CRT) compared to chemotherapy alone (CT) was associated with improved overall survival (OS) in an AEC cohort and among subgroups by stage and histologic grade.
Women who received CT or CRT after hysterectomy and bilateral salpingo-oophorectomy for FIGO stage III–IVA AEC diagnosed in 2004–2012 were identified in the National Cancer Data Base. Multilevel modeling was used to identify covariates associated with treatment selection. OS was compared using Kaplan-Meier estimates, the log-rank test, Cox proportional hazards regression, and propensity score matching.
We identified 9837 patients, of whom 6358 (65%) received CT and 3479 (35%) received CRT. Median follow-up was 59.6 months. OS was higher in patients receiving CRT compared to CT (70% v 55% at 5 years, log-rank P < 0.001). Controlling for stage, histologic grade, tumor size, age, comorbidity and race, CRT remained independently associated with improved OS (HR 0.63, 95% CI 0.57–0.70, P < 0.001). When stratified by stage and histologic grade, there was a significant OS benefit for stage IIIA, IIIB, IIIC, grade 2, and grade 3 (all P < 0.001), a trend for stage IVA (P = 0.06), but no benefit for grade 1 (P = 0.91). On multivariable subgroup analyses, these findings persisted, including lack of benefit in grade 1 patients (HR 0.72, P = 0.14). These results were further confirmed after propensity score matching.
Adjuvant CRT for AEC was associated with improved OS, except for patients with well-differentiated disease, who fared equally well with CT alone.

View all citing articles on Scopus

^☆: Presented at the 30th Annual Meeting of the Society of Gynecologic Oncologists, San Francisco, CA, March 20–24, 1999.

¹: To whom reprint requests should be addressed at Department of Radiation and Cellular Oncology, University of Chicago Hospitals, MC 9006, 5758 S. Maryland Ave, Chicago, IL 60637. Fax: (773) 702-0610. E-mail: [email protected].

View full text

Regular ArticleThe Significance of Adnexal Involvement in Endometrial Carcinoma☆

Abstract

Gynecol Oncol

Int J Radiat Oncol Biol Phys

Gynecol Oncol

Gynecol Oncol

Gynecol Oncol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Gynecol Oncol

Int J Radiat Oncol Biol Phys

Gynecol Oncol

Int J Radiat Oncol Biol Phys

Am J Obstet Gynecol

Gynecol Oncol

Regular Article
The Significance of Adnexal Involvement in Endometrial Carcinoma☆