Management of aggressive histologic variants of endometrial carcinoma at the Tom Baker Cancer Centre between 1984 and 1994

Objective. The aim of this study was to determine the patient characteristi cs and outcome of patients with aggressive histologic variants (AV) of endo metrial carcinoma, including uterine papillary serous carcinoma (UPSC), ute rine clear cell carcinoma (UCCC), and mixed type. Methods and materials. All cases with AV histological type of endometrial c arcinoma from January 1984 to December 1994 at the Tom Baker Cancer Centre were identified using the Alberta Cancer Registry. Relevant data from the c harts of these patients were entered into a study database (Microsoft Excel ) and analyzed for presentation, demography, treatment parameters, and outc ome of treatment. Ail pathology was reviewed at the time of diagnosis. Stat istical analysis was performed using the S-plus statistics computer program . Univariate and multivariate analyses were used to assess independent prog nostic factors using the Cox proportional hazards model. Results. A total of 103 patients with AV histological type were identified and analyzed; there were 61, 31, and 11 cases of UPSC, CCC, and mixed tumor s, respectively. Sixty-three patients had Stage I, 11 had Stage II, 15 had Stage III, and 14 had Stage IV disease. The median age of patients was 67 y ears with a range of 36 to 86 years. Median follow-up was 60 months with a range of 36 to 156 months. The Cox proportional hazards model showed that l ymphvascular space invasion and stage are the two independent prognostic fa ctors affecting recurrence and survival. Forty six percent of ail cases und erwent surgery alone, 39% underwent treatment which included pelvic RT, and 17% underwent treatment which included chemotherapy. Pelvic recurrence was reduced significantly by radiotherapy in Stages I, II, and III (19% recurr ence with no RT vs 7% recurrence with RT, P < 0.005). Chemotherapy improved overall survival, but made little difference in distant relapse rates. Conclusions. Stage Ia cases treated by surgery alone have a low risk of rel apse and need not be offered adjuvant systemic therapy or pelvic radiation. Patients with Ib, Ic, II, and III have significantly lower pelvic failure rates if treated with pelvic radiation, but still have a high distant failu re rate. Systemic therapy did not significantly improve distant relapse-fre e survival, but did extend overall survival. Stage IV patients usually died within 6 months with a few responding to systemic chemotherapy. These resu lts suggest that there is a need for randomized trials for these patients. (C) 2000 Academic Press.