Endometrial adenocarcinoma with clinical evidence of cervical involvement: accuracy of diagnostic procedures, clinical course, and prognostic factors.

BACKGROUND

The accuracy of clinical staging is known to be insufficient in stage II endometrial carcinoma. Also the optimal management of this disease is controversial. In this study we evaluate diagnostic accuracy and prognostic factors with special reference to treatment modalities of stage II endometrial carcinoma.

METHODS

Of 1297 patients with endometrial adenocarcinoma (EAC) treated between 1970 and 1980 at Departments of Obstetrics and Gynecology, Helsinki University Central Hospital, 140 (11%) cases represented clinical stage II and were retrospectively analyzed.

RESULTS

Median age of the patients was 63.5 years (range 40-85 years). Accuracy of Papanicolaou smear was 50%, and that of endocervical curettage 51%. Most of the tumors were histopathologically pure adenocarcinomas (88%), well differentiated (43%), and superficially invaded to myometrium (44%). Thirty-four (24%) of the patients developed a recurrent disease during the first five years afterwards. Median time of recurrency was 17 months (range 4-35 months). The disease free 5- or 10-year survival were 72% and 67%. Survival was significantly correlated with menopausal state (p < 0.01), tumor grade (p < 0.05), myometrial invasion (p < 0.001), surgical stage (p < 0.0001), and mode of treatment, i.e. operation done or not (p < 0.05). Survival was not affected by the radical nature of the operation (radical vs. simple hysterectomy). When all prognostic variables were analyzed by Cox's regression model (multivariate analysis) in 10-years follow-up, only menopausal state, myometrial invasion, and mode of treatment, i.e. operation done or not (p < 0.01), were independent prognostic factors.

CONCLUSIONS

The only relevant staging procedure is the histological examination of cervix without the preoperative irradiation. According to our results it seems that simple hysterectomy instead of radical (Wertheim operation) hysterectomy may be a sufficient operative treatment of stage II endometrial carcinoma.