Survival outcomes in patients with undifferentiated endometrial carcinoma

Yıl 2019, Cilt: 46 Sayı: 1, 141 - 147, 03.03.2019

Alpaslan Kaban Samet Topuz

https://doi.org/10.5798/dicletip.534852

Öz

Objective: The
aim of this study was to investigate the clinicopathological features and
survival of patients with undifferentiated endometrial carcinoma (UEC).

Methods:
Patients who were operated between 2006 and 2014 for endometrial cancer (EC) in
the same center were retrospectively reviewed from the clinical archive. Data
were obtained from patient files. Survival curves and rates were calculated
using the Kaplan-Meier method, and differences in survival were evaluated using
the Log-Rank test.

Results: In
this study, 774 patients with EC were screened. According to the pathology
report, 14 (1.8%) had undifferentiated type histology. The mean age, parity and
body mass index (BMI) of the patients were 58.6 year (range 40-73); 3.28 (range
0-6) and 32.1 kg/m2 (range 22.8-41.7), respectively. Of the patients, 64% (n=9)
had deep myometrial invasion, 93% (n=13) had lymphovascular space invasion, and
57% (n=8) had cervical involvement. Tumor size was greater than 5 cm in 64%
(n=9) of the patients. Thirty five percent (n=5) of the patients were stage 1A,
21% (n=3) were stage 1B, 14% (n=2) were stage 2, 14% were stage 3C, and 14%
were stage 4. As adjuvant therapy, 21% (n=3) of the patients received
chemotherapy only, 14% (n=2) received radiotherapy only, and 57% (n=8) received
chemotherapy and radiotherapy together. The mean follow-up duration was 36
months (range 4-104). In this period, survival rates were 77% for early-stage
(FIGO 1-2) and 0% for advanced-stage (FIGO 3-4). The mean survival duration was
81 months in the early stage; 6.8 months in advanced stage (Log Rank test P
value= 0.001).

Conclusion:
According to this study, UEC is highly associated with pathological poor
prognostic factors such as deep myometrial invasion, lymphovascular space
invasion, cervical involvement and large tumor size. Patients with advanced
stage do not have the chance to survive. Long-term survival is possible if the
diagnosis and treatment of the disease is achieved while the tumor is limited
to the uterus.

Anahtar Kelimeler

Undifferentiated, survival, prognosis, surgery

Kaynakça

• 1. Acharya S, Hensley ML, Montag AC, Fleming GF. Rare uterine cancers. Vol. 6, Lancet Oncology. 2005. p. 961–71.
• 2. Ramalingam P, Masand RP, Euscher ED, Malpica A. Undifferentiated Carcinoma of the Endometrium: An Expanded Immunohistochemical Analysis Including PAX-8 and Basal-Like Carcinoma Surrogate Markers. Int J Gynecol Pathol. 2016; 35: 410-8.
• 3. Altrabulsi B, Malpica A, Deavers MT, et all. Undifferentiated carcinoma of the endometrium. Am J Surg Pathol. 2005; 29: 1316–21.
• 4. Silva EG, Deavers MT, Malpica A. Undifferentiated carcinoma of the endometrium: A review. Pathology. 2007; 39: 134–8.
• 5. Abeler VM, Nesland JM, Kjell E. Kjorstad. Undifferentiated carcinoma of the endometrium. A histopathologic and clinical study of 31 cases. Cancer. 1991; 68: 98–105.
• 6. Garg K, Soslow RA. Endometrial undifferentiated carcinomas. Pathology Case Reviews. 2011.
• 7. Espinosa I, Lee CH, D'Angelo E, Palacios J, Prat J. Undifferentiated and Dedifferentiated Endometrial Carcinomas With POLE Exonuclease Domain Mutations Have a Favorable Prognosis. Am J Surg Pathol. 2017 Aug; 41: 1121-8.
• 8. Eble, John N., Fattaneh A. Tavassoli, and Peter Devilee, eds. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. Iarc, 2003.
• 9. 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: 781–9.
• 10. Koh WJ, Abu-Rustum NR, Bean S, et al. Uterine Neoplasms, Version 1.2018: Clinical practice guidelines in oncology. JNCCN Journal of the National Comprehensive Cancer Network. 2018.
• 11. Markman M. General principles: chemotherapy. In: Berek JS HN, editor. Practical Gynaecologic Oncology. Lipincott Williams and Wilkins; 2004. p. 91.
• 12. Hayashi M, Ueda Y, Takimoto T, Ohkura T. Undifferentiated endometrial carcinoma of the uterus: marked effect of chemotherapy with tetrahydropyranyl-adriamycin, paclitaxel, and carboplatin. Int J Gynecol Cancer. 2004; 14: 388-94