Prognostic Characteristics
Multiple prognostic factors have been identified in endometrial adenocarcinoma. Patient age, histology, degree of differentiation, depth of invasion, and surgical staging are all important prognostic factors. Younger patients have a better prognosis than older individuals. This may be because younger patients tend to have a better-differentiated, superficially invasive cancer. Adenocarcinoma with its variants are by far the most common histologic type. Current data suggest that grade of adenocarcinoma is a more important prognostic indicator than presence of a squamous component.
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Uterine papillary serous carcinoma is recognized as a distinct, highly aggressive carcinoma of the uterus. Patients tend to be older, parous, not obese, and with a high tumor grade. Extrauterine disease is identified frequently with uterine papillary serous carcinoma. Even when disease appears to be limited to the uterus, prognosis is considerably poorer than with adenocarcinoma of similar extent. Fortunately, these tumors are unusual; however, they appear to be diagnosed with increasing frequency. Clear-cell carcinomas occur infrequently, and most studies suggest that clear-cell carcinomas have a poorer prognosis than pure adenocarcinomas.
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The differentiation of the adenocarcinoma has long been recognized as an important prognostic factor. Surgical stage I disease survival is directly related to the grade of the tumor. The grade of the tumor correlates generally with the depth of uterine muscle invasion. As the tumor becomes less differentiated, the chances of deep myometrial involvement increase. These two factors correlate well with extrauterine disease. As a general rule, cancers that are poorly differentiated are associated with greater adnexal and lymph node metastasis and other extrauterine spread. This is also true as the depth of myometrial invasion increases. The role of full surgical staging in determining true extent of the disease becomes apparent. Most studies suggest that the presence of malignant cells in peritoneal cytology is a poor prognostic factor. Tumor cells found in capillary-like spaces within the myometrium have been shown to be predictive of extrauterine metastasis, particularly to the lymph nodes. Other prognostic factors that have been suggested include hormone receptor status, tumor ploidy analysis, and S-phase fraction. Although predictive of prognosis, they have not generally been used in the routine evaluation of endometrial cancer.