The outcome of stage I-II clinically and surgically staged papillary serous and clear cell endometrial cancers when compared with endometrioid carcinoma

Purpose. The aim of this study was to compare survival and recurrence in cl inical and surgical stage I-II papillary serous (PS), clear cell (CC), and endometrioid (EM) cancers of the endometrium and examine the prognostic uti lity of myometrial invasion. Methods. Clinical, surgicopathologic, and survival data were retrospectivel y collected on 574 clinical stage I-II endometrial cancer patients, includi ng 53 PS and 18 CC (based on postoperative histology), undergoing hysterect omy at Duke University Medical Center between 1967 and 1990. All staging ma terial was available and reexamined prior to this analysis, and FIGO surgic al staging was retrospectively assigned. Prognostic variables examined incl uded age, stage, grade, myometrial invasion, lymph-vascular space invasion (LVSI), and histology. PS and CC histologic subtypes were compared as both common category and discrete categories versus EM, EM grade 1 (EM1), EM gra de 2 (EM2), and EM grade 3 (EM3). Statistical analyses were performed using chi(2), Fisher's exact, and Wilcoxon rank sum tests, Cox regression analys is, and Kaplan-Meier survival analysis. Results. PS tumors accounted for 9%, CC for 3%, and EM for 88% of cases. Re currences were more frequent among PS (38%) and CC (22%) compared with EM ( 9%) (P < 0.001 and 0.08, respectively), and PS recurred more frequently tha n EM3 alone (20%) (P = 0.06). Among PS, CC, and EM3 patients with recurrenc es there were no statistical differences in the proportion that received pr eoperative or postoperative radiotherapy or chemotherapy. Prognostic factor s for shorter survival included age >=60, surgical stage III+IV, presence o f LVSI, histology (PS, CC, or EM3), and >=50% myometrial invasion. The esti mated 5-year survival of PS+CC patients with <2 mm myometrial invasion is 0 .56 compared to 0.93 for EM patients (P < 0.001). PS + CC tumors confined t o the endometrium had a 5-year survival of 0.60 compared to 0.98 and 1.00 f or EM and EM3, respectively. The 5-year survival for surgically staged IA p atients (0.57) was not different from stages IB and IC combined (0.53) (P = 0.72). The 5-year survival for surgical stage I + II PS + CC patients (0.5 6) was comparable to that for clinical stage I + II PS + CC patients (0.46) and remained significantly smaller than that for EM patients (0.86) (P < 0 .001). Conclusion. Recurrences are more frequent among PS and CC tumors compared w ith EM and among PS compared with EM3. When controlled for surgical stage I -II tumors, 5-year survival for PS + CC patients remains comparable to that of clinical stage I-II patients and below that of EM. Prognostic factors f or survival in PS and CC patients include age, stage, and LVSI. PS, CC, and EM3 subtypes together are predictors of poor survival. Thorough extended s urgical staging is indicated in PS and CC tumors, and prospective trials of aggressive adjuvant therapies for surgical stage I-II tumors are needed to improve outcome in PS and CC patients. (C) 2000 Academic Press.