Endometrial Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI]-General Infor
Endometrial Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI]-General Information About Endometrial Cancer
Endometrial Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] Guide
Prognostic Factors
Another factor found to correlate with extrauterine and nodal spread of tumor is involvement of the capillary-lymphatic space on histopathologic examination.[13] Three prognostic groupings of clinical stage I disease become possible by careful operative staging. Patients with grade 1 tumors involving only endometrium and no evidence of intraperitoneal disease (i.e., adnexal spread) have a low risk (<5%) of nodal involvement.[14] Patients with grade 2 or 3 tumors and invasion of less than 50% of the myometrium and no intraperitoneal disease have a 5% to 9% incidence of pelvic node involvement and a 4% incidence of positive para-aortic nodes. Patients with deep muscle invasion and high-grade tumors and/or intraperitoneal disease have a significant risk of nodal spread, 20% to 60% to pelvic nodes and 10% to 30% to para-aortic nodes. One study was directed specifically at stage I, grade 1 carcinomas of favorable histologic type. The authors identified the following four statistically significant adverse prognostic factors:[15]
Another group identified aneuploidy and a high S-phase fraction as predictive of poor prognosis.[16] A Gynecologic Oncology Group study related surgical-pathologic parameters and postoperative treatment to recurrence-free interval and recurrence site. For patients without extrauterine spread, the greatest determinants of recurrence were grade 3 histology and deep myometrial invasion. In this study, the frequency of recurrence was greatly increased with positive pelvic nodes, adnexal metastasis, positive peritoneal cytology, capillary space involvement, involvement of the isthmus or cervix, and, particularly, positive para-aortic nodes (includes all grades and depth of invasion). Of the cases with aortic node metastases, 98% were in patients with positive pelvic nodes, intra-abdominal metastases, or tumor invasion of the outer 33% of the myometrium.[17,18]
When the only evidence of extrauterine spread is positive peritoneal cytology, the influence on outcome is unclear. The value of therapy directed at this cytologic finding is not well founded.[19,20,21,22,23,24] As a result, although the collection of cytology specimens is still suggested, a positive result does not upstage the cancer. Other extrauterine disease must be present before additional postoperative therapy is considered.
Endometrial Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - General Information About Endometrial Cancer
Endometrial Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] Guide
- General Information About Endometrial Cancer
- Cellular Classification of Endometrial Cancer
- Stage Information for Endometrial Cancer
- Treatment Option Overview
- Stage I Endometrial Cancer
- Stage II Endometrial Cancer
- Stage III Endometrial Cancer
- Stage IV Endometrial Cancer
- Recurrent Endometrial Cancer
- Changes to This Summary (04 / 23 / 2014)
- About This PDQ Summary
- Get More Information From NCI
Prognostic Factors
Another factor found to correlate with extrauterine and nodal spread of tumor is involvement of the capillary-lymphatic space on histopathologic examination.[13] Three prognostic groupings of clinical stage I disease become possible by careful operative staging. Patients with grade 1 tumors involving only endometrium and no evidence of intraperitoneal disease (i.e., adnexal spread) have a low risk (<5%) of nodal involvement.[14] Patients with grade 2 or 3 tumors and invasion of less than 50% of the myometrium and no intraperitoneal disease have a 5% to 9% incidence of pelvic node involvement and a 4% incidence of positive para-aortic nodes. Patients with deep muscle invasion and high-grade tumors and/or intraperitoneal disease have a significant risk of nodal spread, 20% to 60% to pelvic nodes and 10% to 30% to para-aortic nodes. One study was directed specifically at stage I, grade 1 carcinomas of favorable histologic type. The authors identified the following four statistically significant adverse prognostic factors:[15]
- Myometrial invasion.
- Vascular invasion.
- Eight or more mitoses per ten high-power fields.
- An absence of progesterone receptors.
Another group identified aneuploidy and a high S-phase fraction as predictive of poor prognosis.[16] A Gynecologic Oncology Group study related surgical-pathologic parameters and postoperative treatment to recurrence-free interval and recurrence site. For patients without extrauterine spread, the greatest determinants of recurrence were grade 3 histology and deep myometrial invasion. In this study, the frequency of recurrence was greatly increased with positive pelvic nodes, adnexal metastasis, positive peritoneal cytology, capillary space involvement, involvement of the isthmus or cervix, and, particularly, positive para-aortic nodes (includes all grades and depth of invasion). Of the cases with aortic node metastases, 98% were in patients with positive pelvic nodes, intra-abdominal metastases, or tumor invasion of the outer 33% of the myometrium.[17,18]
When the only evidence of extrauterine spread is positive peritoneal cytology, the influence on outcome is unclear. The value of therapy directed at this cytologic finding is not well founded.[19,20,21,22,23,24] As a result, although the collection of cytology specimens is still suggested, a positive result does not upstage the cancer. Other extrauterine disease must be present before additional postoperative therapy is considered.
Source...