Comparative outcomes assessment of uterine grade 3 endometrioid, serous, and clear cell carcinomas

- Overall survival as a function of histologic subtypes dies not differ statistically, even when controlling for disease stage.
- Age, lymphovascular space involvement, residual nodal disease, and radiotherapy independently affect survival in stage III high-risk uterine cancers.
- Lymphovascular space involvement, cervical stromal invasion, and chemotherapy independently affect survival in stage IV high-risk uterine cancers.

ObjectiveThe objective of this study is to assess effects of clinicopathologic risk factors and contemporary therapeutic interventions on high-risk uterine epithelial carcinoma outcomes.MethodsPatient-, disease-, and treatment-specific variables were annotated. Survival was estimated via the Kaplan-Meier method. Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratios.ResultsFrom 1999 through 2008, therapy with curative intent was initiated for 119 grade 3 endometrioid (G3EC), 211 serous (USC), and 40 clear cell (CCC) carcinomas. Although clinicopathologic risk factors varied among the histologic subtypes, overall survival (OS) did not differ statistically between subtypes (P = .10) or in stage-for-stage comparative analyses (stage I/II, P = .45; stage III, P = .46; stage IV, P = .65). The 5-year cause-specific survival in stage I/II was 84.8%, 89.8%, and 83.9% for G3EC, USC, and CCC, respectively; multivariable modeling identified lymphovascular space involvement (LVSI) as the only independent prognostic factor (P = .02). For stage III, 5-year OS was 49.2% and 40.0% for G3EC and USC, respectively; multivariable modeling identified age (P < .001), LVSI (P < .001), unresectable nodal disease (P = .03), and regional radiotherapy (P = .01) as independent prognostic factors. For stage IV, 5-year OS was 8.7% and 12.1% for G3EC and USC, respectively; multivariable modeling identified LVSI (P = .002), cervical stromal invasion (P = .02), and adjuvant chemotherapy (P = .02) but not residual disease as independent prognostic factors.ConclusionsWhen controlled for disease stage, outcomes did not differ among high-risk histologic subtypes. LVSI was a significant adverse prognostic factor within all stages. The lack of improved outcomes with contemporary therapy suggests that more innovative therapeutic approaches should be given higher priority.