Comparative Survival Outcomes of Uterine Papillary Serous Carcinoma, Clear Cell Carcinoma, Grade 3 Endometrioid Adenocarcinoma, and Carcinosarcoma of Endometrial Cancer in Rajavithi Hospital
Nisa Prueksaritanond MD*, Wasu Chantape MD**
Affiliation : * Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand ** Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand
Background : Uterine papillary serous carcinoma (UPSC), clear cell carcinoma (CC), grade 3 endometrioid adenocarcinoma
(G3EC), and carcinosarcoma (CS) have been identified as high-grade endometrial cancers and account for the majority of
uterine cancer deaths.
Objective : To compare survival outcomes of patients with UPSC, CC, G3EC and CS in Rajavithi Hospital.
Material and Method: A retrospective review was performed of all patients with FIGO stage I-IV endometrial cancer in
Rajavithi Hospital between 1 January 2007 and 31 December 2012. Kaplan-Meier estimates were made of overall survival
(OS) and progression-free survival (PFS), and log-rank tests were used to compare survival distributions between histological
subtypes. Cox regression was used to estimate hazard ratios for histological subtypes, adjusted for other significant prognostic
factors.
Results : One hundred sixty-three patients had confirmed diagnosis of high-grade endometrial cancer: 45 had UPSC, 30 had
CC; 58 had G3EC; and 30 had CS. The median age distribution of the four groups of patients was approximately 60 years.
The body mass index, underlying disease, and parity were similar in each group. All patients underwent a hysterectomy and
surgical staging procedure. The 2-year progression-free survival was poorest in the CS cases (79.4%), followed by CC
(87.2%), G3EC (92.2%), and UPSC cases (95.5%), and these figures were statistically significantly different among the
groups (p = 0.015). The 2-year overall survival was poorest in the CC cases (70.0%), followed by CS (76.7%), UPSC
(86.7%), and G3EC (87.9%); however, there were no significant differences among the groups (p = 0.071). In multivariate
analysis for OS, advanced stage and suboptimal surgery were significantly associated with increased risk of death. For PFS,
advanced stage and positive peritoneal cytology were significantly associated with increased risk of recurrence.
Conclusion : CS patients had a significantly lower rate of progression-free survival than other subtypes. These findings
should be taken into account when considering counseling, primary treatment and appropriate adjuvant treatment in order
to improve survival outcomes in these high-risk patients.
Keywords : Overall survival, Progression-free survival, Grade 3 endometrioid adenocarcinoma, Carcinosarcoma, Clear cell carcinoma, Uterine papillary serous carcinoma
