Examination of Factors Affecting Prognosis and Treatment Choice in Patients with Endometrial Cancer: A Retrospective Single-Center Experience
Received Date : 08 Aug 2022
Accepted Date : 04 Oct 2023
Available Online : 11 Oct 2023
Doi: 10.37047/jos.2022-92811 - Article's Language: EN
Journal of Oncological Sciences. 2023;9(3):121-7.
This is an open access article under the CC BY-NC-ND license
Objective: The classification of endometrial cancer, based on histology, provides important prognostic information and is pivotal for assessing appropriate surgical and adjuvant therapy. However, molecular determinants could be incorporated to improve the current classification system. Materials and Methods: In our study,Seventy patients diagnosed with endometrial cancer between 2016 and 2021 were included. Pathological type, stage at diagnosis, the date of initiation of treatment, survival information, and molecular characteristics of the patients were recorded.The chi-square test was used to analyze categorical variables.Independent groups were compared using an independent sample t-test and Mann-Whitney-U test. Overall survival was estimated using the Kaplan-Meier method, and results were compared using the log-rank test. The independent prognostic risk factors were analyzed using the Cox regression model. Results: The primary findings obtained were as follows: (1) Median overall survival in de novo metastatic cases was significantly lower than that in patients with subsequent relapse; (2) The most common endometrioid type was observed based on the histopathological examination results. The undifferentiated endometrial cancer subtype demonstrated a highly aggressive course; (3) In the present study, p16 was positive at a significantly higher rate over 60 years of age (p = 0.027). Conclusion: Various prognostic factors were examined in this study. Molecular markers may have an important role in determining the prognosis of endometrial cancer. The positivity of molecular markers such as p16 may contribute to mortality, especially in the geriatric age group.
  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30. [Crossref]  [PubMed] 
  2. Amant F, Mirza MR, Koskas M, Creutzberg CL. Cancer of the corpus uteri. Int J Gynaecol Obstet. Oct 2018;143 Suppl 2:37-50. [Crossref]  [PubMed] 
  3. Elit LM, Pond G, Seow H. Time interval between endometrial biopsy and surgical staging for type I endometrial cancer: association between tumor characteristics and survival outcome. Obstet Gynecol. 2015;125(6):1497-1498. [Crossref]  [PubMed] 
  4. Felix AS, Weissfeld JL, Stone RA, et al. Factors associated with Type I and Type II endometrial cancer. Cancer Causes Control. 2010;21(11):1851-1856. [Crossref]  [PubMed]  [PMC] 
  5. Hamilton CA, Cheung MK, Osann K, et al. Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers. Br J Cancer. 2006;94(5):642-646. [Crossref]  [PubMed]  [PMC] 
  6. Brinton LA, Felix AS, McMeekin DS, et al. Etiologic heterogeneity in endometrial cancer: evidence from a Gynecologic Oncology Group trial. Gynecol Oncol. 2013;129(2):277-284. [Crossref]  [PubMed]  [PMC] 
  7. Zannoni GF, Vellone VG, Arena V, et al. Does high-grade endometrioid carcinoma (grade 3 FIGO) belong to type I or type II endometrial cancer? A clinical-pathological and immunohistochemical study. Virchows Arch. 2010;457(1):27-34. [Crossref]  [PubMed] 
  8. Abu-Rustum NR, Zhou Q, Gomez JD, et al. A nomogram for predicting overall survival of women with endometrial cancer following primary therapy: toward improving individualized cancer care. Gynecol Oncol. 2010;116(3):399-403. [Crossref]  [PubMed]  [PMC] 
  9. Bendifallah S, Canlorbe G, Raimond E, et al. A clue towards improving the European Society of Medical Oncology risk group classification in apparent early stage endometrial cancer? Impact of lymphovascular space invasion. Br J Cancer. 2014;110(11):2640-2646. [Crossref]  [PubMed]  [PMC] 
  10. Kong TW, Chang SJ, Paek J, Lee Y, Chun M, Ryu HS. Risk group criteria for tailoring adjuvant treatment in patients with endometrial cancer: a validation study of the Gynecologic Oncology Group criteria. J Gynecol Oncol. 2015;26(1):32-39. [Crossref]  [PubMed]  [PMC] 
  11. Barlin JN, Soslow RA, Lutz M, et al. Risk group criteria for tailoring adjuvant treatment in patients with endometrial cancer: a validation study of the Gynecologic Oncology Group criteria. J Gynecol Oncol. 2015;26(1):32-39. [Crossref]  [PubMed]  [PMC] 
  12. Abu-Rustum NR, Gomez JD, Alektiar KM, et al. The incidence of isolated paraaortic nodal metastasis in surgically staged endometrial cancer patients with negative pelvic lymph nodes. Gynecol Oncol. 2009;115(2):236-238. [Crossref]  [PubMed] 
  13. Babaoğlu AB, Tekindal M, Büyükuysal MÇ, et al. [Reporting of Observational Studies in Epidemiology: Turkish Adaptation of STROBE Criteria]. Med J West Black Sea. 2021;5(1):86-93. [Crossref] 
  14. Tafe LJ, Garg K, Chew I, Tornos C, Soslow RA. Endometrial and ovarian carcinomas with undifferentiated components: clinically aggressive and frequently underrecognized neoplasms. Mod Pathol. 2010;23(6):781-789. [Crossref]  [PubMed] 
  15. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74-108. [Crossref]  [PubMed] 
  16. Chi DS, Welshinger M, Venkatraman ES, Barakat RR. The role of surgical cytoreduction in Stage IV endometrial carcinoma. Gynecol Oncol. 1997;67(1):56-60. [Crossref]  [PubMed] 
  17. Bristow RE, Zerbe MJ, Rosenshein NB, Grumbine FC, Montz FJ. Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival. Gynecol Oncol. 2000;78(2):85-91. [Crossref]  [PubMed] 
  18. Kim JW, Kim SH, Kim YT, Kim DK. Clinicopathologic and biological parameters predicting the prognosis in endometrial cancer. Yonsei Med J. 2002;43(6):769-778. [Crossref]  [PubMed] 
  19. Obermair A, Geramou M, Tripcony L, Nicklin JL, Perrin L, Crandon AJ. Peritoneal cytology: impact on disease-free survival in clinical stage I endometrioid adenocarcinoma of the uterus. Cancer Lett. 2001;164(1):105-110. [Crossref]  [PubMed] 
  20. Łapińska-Szumczyk S, Emerich J. [Clinical value of pelvic lymphadenectomy in surgical treatment of endometrial cancer]. Ginekol Pol. 2002;73(11):976-979. Polish. [PubMed] 
  21. Burton JL, Wells M. Recent advances in the histopathology and molecular pathology of carcinoma of the endometrium. Histopathology. 1998;33(4):297-303. [Crossref]  [PubMed] 
  22. Lachance JA, Everett EN, Greer B, et al. The effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol. 2006;101(3):470-475. [Crossref]  [PubMed] 
  23. Kim N, Kim YN, Lee K, et al. Feasibility and clinical applicability of genomic profiling based on cervical smear samples in patients with endometrial cancer. Front Oncol. Aug 2022;12:942735. [Crossref]  [PubMed]  [PMC] 
  24. Guan J, Xie L, Luo X, et al. The prognostic significance of estrogen and progesterone receptors in grade I and II endometrioid endometrial adenocarcinoma: hormone receptors in risk stratification. J Gynecol Oncol. 2019;30(1):e13. [Crossref]  [PubMed]  [PMC] 
  25. Lax SF. Molecular genetic pathways in various types of endometrial carcinoma: from a phenotypical to a molecular-based classification. Virchows Arch. 2004;444(3):213-223. [Crossref]  [PubMed] 
  26. Matson DR, Accola MA, Henderson L, et al. A "null" pattern of p16 immunostaining in endometrial serous carcinoma: an under-recognized and important aberrant staining pattern. Int J Gynecol Pathol. 2022;41(4):378-388. [Crossref]  [PubMed]  [PMC] 
  27. Dong Y, Walsh MD, McGuckin MA, et al. Increased expression of cyclin-dependent kinase inhibitor 2 (CDKN2A) gene product P16INK4A in ovarian cancer is associated with progression and unfavourable prognosis. Int J Cancer. 1997;74(1):57-63. [Crossref]  [PubMed] 
  28. Yemelyanova A, Ji H, Shih IeM, Wang TL, Wu LS, Ronnett BM. Utility of p16 expression for distinction of uterine serous carcinomas from endometrial endometrioid and endocervical adenocarcinomas: immunohistochemical analysis of 201 cases. Am J Surg Pathol. 2009;33(10):1504-1514. [Crossref]  [PubMed] 
  29. Chen W, Husain A, Nelson GS, Rambau PF, Liu S, Lee CH, Lee S, Duggan MA, Köbel M. Immunohistochemical Profiling of Endometrial Serous Carcinoma. Int J Gynecol Pathol. 2017;36(2):128-39. [Crossref]  [PubMed]