Uterin seröz karsinomda seröz endometrial intraepitelyal karsinom varlığının prognostik değeri

Year 2024, Volume: 49 Issue: 2, 239 - 247, 30.06.2024

Günsu Kimyon Cömert , Burak Ersak , Abdurrahman Alp Tokalıoglu , Fatih Çelik , Duygu Tuğrul Ersak , Sevgi Ayhan , Fatih Kılıç , Osman Türkmen , Özlem Moraloğlu Tekin , Taner Turan

https://doi.org/10.17826/cumj.1392952

Abstract

Amaç: Literatürde halen nadir bir antite olan seröz endometrial intraepitelyal karsinom (SEIC) ile birlikte olan veya olmayan uterin seröz karsinomun (USC) klinik-patolojik bulgularını, prognozunu ve sağkalım sonuçlarını araştırmak.
Gereç ve Yöntem: En az histerektomi yapılmış toplam 98 USC hastası incelendi. Dışlama kriterlerinden sonra, cerrahi evreleme yapılan toplam 76 USC'li hasta değerlendirildi. SEIC, invaziv yüksek dereceli endometriyal karsinoma benzeyen oldukça atipik hücreler tarafından stromanın invazyonu olmaksızın komşu atrofik endometriyumun yüzeyinin ve glandlarının değiştirilmesi olarak tanımlandı. Ameliyattan ölüme veya son ziyarete kadar geçen süre genel sağkalım (OS) olarak tanımlanmıştır.
Bulgular: Hastaların yarısında (n:38) SEIC varlığı gözlendi. SEIC'li USC'li hastalar daha yaşlıydı ve SEIC olmayanlara göre daha yüksek polipoid paterni vardı. 5 yıllık genel sağkalım (OS), SEIC olan ve olmayan hastalarda sırasıyla %44,8 ve %62,4 idi. SEIC'li veya SEIC'siz USC'li hastalarda diğer klinikopatolojik faktörler için istatistiksel anlamlılık yoktu İleri evre istatistiksel olarak 2,45 kat fazla ölüm riski ile ilişkiliydi. Ayrıca, evre, USC için OS'nin tek bağımsız faktörü olarak bulundu. SEIC'li USC'li hastalarda ise OS için tek bağımsız prognostik faktör olarak lenfovasküler alan tutulumu saptandı.
Sonuç: Polipoid patern varlığı SEIC dahil USC hastalarında anlamlı olarak daha yüksek olmasına rağmen, bağımsız olarak sağkalım ile ilişkili değildi. Evre, USC için OS ile ilişkili tek prognostik faktördü. Bununla birlikte, SEIC varlığının USC'nin sağkalımı üzerinde prognostik bir etkisi yoktu.

Keywords

Seröz adenokarsinom, seröz intraepitelyal neoplazi, uterus, sağkalım

Prognostic value of the presence of serous endometrial intraepithelial carcinoma in uterine serous carcinoma

Abstract

Purpose: To investigate the clinical-pathological findings, prognosis, and survival outcome of uterine serous carcinoma (USC) with or without serous endometrial intraepithelial carcinoma (SEIC) which is still a rare entity in literature.
Materials and Methods: A total of 98 patients with USC who underwent at least a hysterectomy were reviewed. After elimination for exclusion criteria, totally 76 patients with USC who had surgical staging were evaluated. SEIC was defined as the replacement of the surface and glands of the adjacent atrophic endometrium without invasion of the stroma by the highly atypical cells resembling invasive high-grade endometrial carcinoma. The period from surgery to death or last visit was defined as overall survival (OS).
Results: The presence of SEIC was observed in half (n:38). Patients who had USC with SEIC were older and had a higher polypoid pattern than those without SEIC. The 5-year overall survival (OS) was 44.8% and 62.4% in patients with and without SEIC, respectively. There was no statistical significance for other clinicopathological factors in patients who had USC with or without SEIC. The advanced stage was related to a statistically significant hazard ratio for death of 2.45. Furthermore, the stage was found as the only independent factor of OS for USC. And, lymphovascular space involvement was determined as the only independent prognostic factor for OS in patients that had USC with SEIC.
Conclusion: Although the presence of polypoid pattern was significantly higher in patients who had USC including SEIC, it was not associated with survival independently. The stage was the only prognostic factor related to OS for USC. However, the presence of the SEIC had no prognostic effect on the survival of USC.

Keywords

Serous adenocarcinoma, serous intraepithelial neoplasia, uterus, survival

References

• Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al. Global cancer statistics 2020: CA Cancer J Clin. 2021;71:209-49.
• Moore KN, Fader AN. Uterine papillary serous carcinoma. Clin Obstet Gynecol. 2011;54:278-91.
• Hamilton C, Cheung M, Osann K, Chen L, Teng N, Longacre T et al. Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers. Br J Cancer. 2006;94:642-6.
• DeLair DF, Burke KA, Selenica P, Lim RS, Scott SN, Middha S et al. The genetic landscape of endometrial clear cell carcinomas. J Pathol. 2017;243:230-41.
• Lax SF. Pathology of endometrial carcinoma. Adv Exp Med Biol. 2017;943:75-96.
• Gehrig PA, Groben PA, Fowler WC, Jr., Walton LA, Van Le L. Noninvasive papillary serous carcinoma of the endometrium. Obstet Gynecol. 2001;97:153-7.
• Goff BA, Kato D, Schmidt RA, Ek M, Ferry JA, Muntz HG et al. Uterine papillary serous carcinoma: patterns of metastatic spread. Gynecol Oncol. 1994;54:264-8.
• Hou JY, McAndrew TC, Goldberg GL, Whitney K, Shahabi S. A clinical and pathologic comparison between stage-matched endometrial intraepithelial carcinoma and uterine serous carcinoma: is there a difference? Reprod Sci. 2014;21:532-7.
• Soslow RA, Pirog E, Isacson C. Endometrial intraepithelial carcinoma with associated peritoneal carcinomatosis. Am J Surg Pathol. 2000;24:726-32.
• Hedley C, Sriraksa R, Showeil R, Van Noorden S, El-Bahrawy M. The frequency and significance of WT-1 expression in serous endometrial carcinoma. Hum Pathol. 2014;45:1879-84.
• Trinh VQ, Pelletier MP, Echelard P, Warkus T, Sauthier P, Gougeon F, et al. Distinct histologic, immunohistochemical and clinical features associated with serous endometrial intraepithelial carcinoma involving polyps. Int J Gynecol Pathol. 2020;39:128-35.
• Wheeler DT, Bell KA, Kurman RJ, Sherman ME. Minimal uterine serous carcinoma: diagnosis and clinicopathologic correlation. Am J Surg Pathol. 2000;24:797-806.
• Shimizu M, Yamanaka K, Azumi M, Tomimoto M, Washio K, Takahashi R et al. A case of synchronous serous ovarian cancer and uterine serous endometrial intraepithelial carcinoma. J Ovarian Res. 2021;14:87.
• Ronsini C, Reino A, Molitierno R, Vastarella MG, La Mantia E, De Franciscis P. Critical overview of serous endometrial intraepithelial cancer treatment: systematic review of adjuvant options. Life (Basel). 2023;13:1429.
• WHO Classification of Tumours Editorial Board, Female Genital Tumours (Who classification of tumours series volume 4). International Agency for Research on Cancer. 2020;5th edition.
• Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105:103-4.
• Ambros RA, Sherman ME, Zahn CM, Bitterman P, Kurman RJ. Endometrial intraepithelial carcinoma: a distinctive lesion specifically associated with tumors displaying serous differentiation. Hum Pathol. 1995;26:1260-7.
• Zheng W, Schwartz PE. Serous EIC as an early form of uterine papillary serous carcinoma: recent progress in understanding its pathogenesis and current opinions regarding pathologic and clinical management. Gynecol Oncol. 2005;96:579-82.
• Yoshioka T, Suzuki Y, Imai Y, Ruiz-Yokota N, Yamanaka S, Furuya M et al. Inspection for micrometastasis is essential for predicting the prognosis of serous endometrial intraepithelial carcinoma: Case report and literature review. J Obstet Gynaecol Res. 2021;47:4484-9.
• FC CS, Hofhuis W, Hoogduin K, PC PE-G, HJ HvB. Serous endometrial intraepithelial carcinoma (SEIC). Eur J Obstet Gynecol Reprod Biol. 2021;265:25-9.
• Farrell R, Scurry J, Otton G, Hacker NF. Clinicopathologic review of malignant polyps in stage 1A carcinoma of the endometrium. Gynecol Oncol. 2005;98:254-62.
• Trahan S, Têtu B, Raymond PE. Serous papillary carcinoma of the endometrium arising from endometrial polyps: a clinical, histological, and immunohistochemical study of 13 cases. Hum Pathol. 2005;36:1316-21.
• Yadav S, Agarwal A, Mokal S, Menon S, Rekhi B, Deodhar K. Serous endometrial intraepithelial carcinoma: A clinico-pathological study of 48 cases and its association with endometrial polyps - A tertiary care oncology centre experience. Eur J Obstet Gynecol Reprod Biol. 2021;264:168-72.
• Abushahin N, Zhang T, Chiang S, Zhang X, Hatch K, Zheng W. Serous endometrial intraepithelial carcinoma arising in adenomyosis: a report of 5 cases. Int J Gynecol Pathol. 2011;30:271-81.
• Kuhn E, Wu RC, Guan B, Wu G, Zhang J, Wang Y et al. Identification of molecular pathway aberrations in uterine serous carcinoma by genome-wide analyses. J Natl Cancer Inst. 2012;104:1503-13.
• Yasuda M. Immunohistochemical characterization of endometrial carcinomas: endometrioid, serous and clear cell adenocarcinomas in association with genetic analysis. J Obstet Gynaecol Res. 2014;40:2167-76.
• Roelofsen T, van Kempen LC, van der Laak JA, van Ham MA, Bulten J, Massuger LF. Concurrent endometrial intraepithelial carcinoma (EIC) and serous ovarian cancer: can EIC be seen as the precursor lesion? Int J Gynecol Cancer. 2012;22:457-64.
• Tolcher MC, Swisher EM, Medeiros F, Lima JF, Hilderbrand JL, Donovan JL et al. Characterization of precursor lesions in the endometrium and fallopian tube epithelium of early-stage uterine serous carcinoma. Int J Gynecol Pathol. 2015;34:57-64.
• Wheeler DT, Bell KA, Kurman RJ, Sherman ME. Minimal uterine serous carcinoma: diagnosis and clinicopathologic correlation. Am J Surg Pathol. 2000;24:797-806.
• Roelofsen T, van Ham MA, Wiersma van Tilburg JM, Zomer SF, Bol M, Massuger LF et al. Pure compared with mixed serous endometrial carcinoma: two different entities? Obstet Gynecol. 2012;120:1371-81.
• Sagr ER, Denschlag D, Kerim-Dikeni A, Stanimir G, Gitsch G, Gilbert L. Prognostic factors and treatment-related outcome in patients with uterine papillary serous carcinoma. Anticancer res. 2007;27:1213-7