Serous component may mean poorer prognosis in endometrial cancer

In women with early stage grade 3 endometrioid carcinoma, the presence of a serous component is associated with a worse prognosis, researchers report in the November 15th issue of Cancer.

Dr. Paola A. Gehrig and colleagues at the University of North Carolina at Chapel Hill School of Medicine, note that many studies have shown worse outcomes for women with uterine serous carcinoma (USC) compared with uterine endometrioid carcinoma in general.However, it is not known if there is a survival difference between USC and grade 3 endometrioid cancer (G3EC), “both of which are considered poorly differentiated histologic types,” the researchers point out. “Exactly what percentage of serous component is necessary before its presence becomes a negative prognostic indicator” appears to be unknown.To investigate, the researchers compared outcomes for 52 patients with G3EC with no serous component and 87 with a mixed tumor type.Those with USC were more than twice as likely to present with extrauterine disease, the authors found, and three times as likely to have cervical involvement.For women with early stage (Stage I/II) disease whose tumors were greater than 50% USC, the hazard ratio for death was 5.9 compared with tumors with no serous component. For progression-free survival, the corresponding ratio was 3.7. Overall survival at 5 years was 43% versus 89%.Furthermore, there was a significant trend to this effect when comparing overall survival of women with G3EC and those with an involvement ranging from less than less than 10% to greater than 50% USC.”This,” say the authors, “suggests the presence of an underlying difference in the behavior of uterine carcinomas with as little as a 10% serous component.”However, for those with late stage (Stage III/IV) disease, overall survival and progression-free survival did not differ significantly, even when USC exceeded 50%. Survival at 5 years was 58% for G3EC and 53% for USC.Summing up, the researchers conclude that “understanding the significance of the percentage of USC comprising a uterine carcinoma… will allow for the development of more effective treatment for women with this disease.”In a related editorial, Dr. Adnan R. Munkarah, at Wayne State University in Detroit, observes that many questions about USC remain unanswered.In particular, he advocates formation of cooperative groups that can prospectively gather information and plan and carry out studies of different treatment modalities.(Source: Cancer 2004;101:2152-2154,2214-2221: Reuters Health: Oncolink: November 2004.)