Prognostic significance of serous and clear cell adenocarcinoma in surgically staged endometrial carcinoma

Background The serous adenocarcinoma (SA) and clear cell adenocarcinoma (CC A) of endometrium have been shown to be associated with high relapse rate a nd poor survival. It is not clear whether prognostic significance of these specific cell types of tumor is independent of retroperitoneal lymph node m etastasis and other histopathologic prognostic factors in endometrial carci noma. Methods. We examined 240 consecutive patients with clinical stage I to stag e III endometrial carcinoma who were treated prospectively with radical sur gery and/or platinum-based chemotherapy. Surgery included extended hysterec tomy, bilateral salpingo-oophorectomy, and systematic pelvic and paraaortic lymph node dissection. Prognostic significance of various histopathologic factors was determined by Cox regression analysis. Results. SA/CCA were more frequently associated with deep myometrial invasi on, high nuclear grade (G3), lymph-vascular space invasion (LVSI), and pelv ic lymph node metastasis when compared to endometrioid adenocarcinoma (EMA) . Of 216 clinically staged stage I or II disease, seven of 12 cases of SA/C CA had extrauterine disease. This incidence was much higher than that for E MA (46/204) (p<0.01). A multivariate Cox regression analysis revealed that cell type, grade, LVSI, and paraaortic node metastasis (PANM) were independ ent prognosticators. Conclusions. Prognosis of patients with endometrial carcinoma depends on ce ll type, grade, LVSI, and PANM. Poor prognosis for patients with SA/CCA is independent of lymph node metastasis and other histopathologic prognostic f actors. The SA/CCA should be strictly discriminated from EMA.