Carcinoma of the endometrium. V. An analysis of prognosticators in patients with favorable subtypes and Stage I disease.

A review of the pathologic material from patients in our population based uterine cancer registry in Louisville, Kentucky identified three subtypes of endometrial carcinoma with a favorable prognosis: adenoacanthoma, adenocarcinoma with no specific features, and secretory carcinoma. Three subtypes with a much less favorable prognosis were papillary carcinoma, mixed adenosquamous carcinoma, and clear cell carcinoma. The other important determinants of treatment results were: stage of disease, age, race, nuclear grade, and depth of myometrial invasion. This study evaluated these prognostic determinants for the favorable subtypes with Stage 1 disease that were fully treated. There were 595 patient eligible for five-year and 380 for ten-year vital status evaluation. Only three patients were lost to follow-up at five years and four at ten years. The five-year survival was 88.1% and the ten-year 74.5%. At five years 4.4% were dead of disease and at ten years 6.3%. There were 115 women younger than age 50. Their five-year survival was 98.3% and at ten years 94.6%. None was dead of disease at five years and only one at ten years. Black women had a significantly lower survival than did white women, but no black woman younger than age 50 died of disease. Nuclear grade was the most important histologic determinant of survival, followed by depth of myometrial invasion. Recommendations for treatment planning were formulated based on these prognosticators.