Simultaneously detected endometrial and ovarian carcinomas - A prospectiveclinicopathologic study of 74 cases: A gynecologic oncology group study

Objectives. The coexistence of carcinomas of the endometrium and ovary occu rs in about 10% of women with ovarian carcinoma. It is often unclear whethe r this represents synchronous primary tumors or metastasis from endometrium to ovary, or from ovary to endometrium; consequently, staging, therapy, an d expected outcome are uncertain. The Gynecologic Oncology Group sought to study patients with simultaneously detected adenocarcinomas in the endometr ium and ovary with disease grossly confined to the pelvis to explore the po ssible correlation among discrete tumor subsets, natural history, and survi val. Methods. Between 1985 and 1991, 85 patients were prospectively enrolled, of whom 74 were eligible. All were initially treated with total abdominal hys terectomy, bilateral salpingo-oophorectomy, and staging laparotomy, with ra diation and chemotherapy left to the discretion of the treating physician a nd patient. Fifteen pathologic variables were examined to identify differen ces in tumor behavior. Results. Of the 74 patients, 23 (31%) had microscopic spread of tumor in th e pelvis or abdomen. Sixty-four (86%) patients had endometrioid carcinomas in both the endometrium and the ovary, and endometriosis was found in the o vary of 23 (31%) patients. There was concordance between the histologic gra de of the tumor in the ovary and the uterus in 51 (69%) patients. The estim ated probability of recurrence 5 years following staging surgery is 15.1% ( 95% confidence interval (CI): 8.7-25.2%). The presence of metastasis discri minated two groups of patients that experienced different probabilities of recurrence within 5 years: 10.0% (95% CI: 4.32-21.3%) for those with tumors confined to the uterus and ovary and 27.1% (95% CI: 13.0-48.5%) for those with metastasis (hazard ratio = 4.6, P = 0.006). The histologic grades of o varian and uterine tumors also distinguished groups of patients with differ ent probabilities of recurrence at 5 years: 8.0% (95% CI: 2.8-21.3%) for th ose patients with no more than grade 1 disease at either site and 22.4% (95 % CI: 11.8-38.4%) for those with a higher grade in either the ovary or the endometrium (hazard ratio = 3.1, P = 0.047). The estimated overall probabil ity of surviving 5 years is 85.9% and that of surviving 10 years is 80.3%. Conclusion. The prognosis for women with simultaneously detected carcinomas in the uterus and ovary with gross disease confined to the pelvis is surpr isingly good, particularly for those with disease microscopically limited t o the uterus and ovary or of low histologic grade. (C) 2001 Academic Press.