COMPARISON OF CLINICOPATHOLOGICAL AND SURVIVAL ANALYSIS OF ENDOMETRIAL DEDIFFERENTIATED, UNDIFFERENTIATED CARCINOMAS AND CARCINOSARCOMAS

Authors

  • Usman Hassan Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore-Pakistan
  • Iram Asrar Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore-Pakistan
  • Hina Maqbool Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore-Pakistan
  • Mudassar Hussain Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore-Pakistan
  • Maryam Hameed Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore-Pakistan
  • Asif Loya Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore-Pakistan

DOI:

https://doi.org/10.55519/JAMC-03-13746

Abstract

Background: Endometrial cancer ranks as the sixth frequently detected cancer and the 14th highest contributor, to cancer-related fatalities, among women globally. High-grade endometrial carcinomas encompass a diverse array of clinically aggressive tumors, including FIGO grade 3 endometrioid adenocarcinoma, uterine papillary serous carcinoma (UPSC), clear cell carcinoma, undifferentiated carcinoma, dedifferentiated carcinoma, and carcinosarcoma. The classification and diagnosis of these tumors pose challenges due to the absence of well-established molecular markers or panels The main purpose of this study is to assess and compare the clinicopathological characteristics of and survival rates of undifferentiated endometrial carcinoma (UEC), dedifferentiated carcinoma (DEC), and carcinosarcoma (CS) in the Pakistani population at SKMCH&RC. Methods: All patients diagnosed with DEC, UEC, and CS were analyzed from January 2011 and December 2022. Clinicopathological and survival data was retrospectively reviewed and analyzed using SPSS version 27. Kaplan-Meier analysis was used to calculate overall survival (OS) and disease-free survival (DFS). Results: Among 71 selected patients, 47.9% had CS, 29.6% had DEC, and 22.5% had UEC. Mean±S.D age at diagnosis was 58.18±11.35 years. A statistically significant association of DEC, UEC, and CS was identified (p-value <0.05) with myometrial invasion (p=0.02), lymphovascular invasion(p=0.006), positive margins(p=0.003), and involvement of adnexa/ parametria/ vaginal /other organ (p=0.01). The commonest pathological stage was pT1 38(53.5%). 56.3% of patients received chemotherapy, 29.6% received radiotherapy, and 38.0% received a combination of chemotherapy and radiation treatment. Recurrence occurred in 19.7% and death occurred in 37.7% of patients. The highest 5-year OS rate for pathological stage 1 was 59.1% (95% C.I: 42.9–81.3%) and 5-year-DFS was 62.2% (95% C.I: 42.9–81.3%). Conclusion: Patients diagnosed at an early pathological stage demonstrate better survival outcomes compared to an advanced stage, as documented in previous studies. Nevertheless, survival rates remain lower than Western population, indicating a necessity for gathering additional clinical data and alter the management strategies in our population.  

References

Lortet-Tieulent J, Ferlay J, Bray F, Jemal A. International patterns and trends in endometrial cancer incidence, 1978–2013. JNCI: Journal of the National Cancer Institute. 2018 Apr 1;110(4):354-61.

Kobayashi Y, Kitazono I, Akahane T, Yanazume S, Kamio M, Togami S, et al. Molecular evaluation of endometrial dedifferentiated carcinoma, endometrioid carcinoma, carcinosarcoma, and serous carcinoma using a custom-made small cancer panel. Pathology & Oncology Research. 2021 Dec 23;27:1610013.

Huvila J, Pors J, Thompson EF, Gilks CB. Endometrial carcinoma: molecular subtypes, precursors and the role of pathology in early diagnosis. The Journal of Pathology. 2021 Apr;253(4):355-65.

Santoro A, Angelico G, Travaglino A, Inzani F, Arciuolo D, Valente M, et al. . New pathological and clinical insights in endometrial cancer in view of the updated ESGO/ESTRO/ESP guidelines. Cancers. 2021 May 26;13(11):2623.

Kasius JC, Pijnenborg JM, Lindemann K, Forsse D, van Zwol J, Kristensen GB, et al. Risk stratification of endometrial cancer patients: FIGO stage, biomarkers and molecular classification. Cancers. 2021 Nov 22;13(22):5848.

Hamilton SN, Tinker AV, Kwon J, Lim P, Kong I, Sihra S, et al. Treatment and outcomes in undifferentiated and dedifferentiated endometrial carcinoma. Journal of Gynecologic Oncology. 2022 May;33(3).

Li Z, Zhao C. Clinicopathologic and immunohistochemical characterization of dedifferentiated endometrioid adenocarcinoma. Applied Immunohistochemistry & Molecular Morphology. 2016 Sep 1;24(8):562-8.

Bansal N, Herzog TJ, Seshan VE, Schiff PB, Burke WM, Cohen CJ, et al. Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstetrics & Gynecology. 2008 Jul 1;112(1):64-70.

Lakhwani P, Agarwal P, Goel A, Nayar N, Pande P, Kumar K. High-Grade Endometrial Cancer—Behaviour and Outcomes at a Tertiary Cancer Centre. Indian Journal of Surgical Oncology. 2019 Dec;10(4):662-7.

Murali R, Davidson B, Fadare O, Carlson JA, Crum CP, Gilks CB, et al. High-grade endometrial carcinomas: morphologic and immunohistochemical features, diagnostic challenges and recommendations. International Journal of Gynecological Pathology. 2019 Jan 1;38:S40-63.

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Published

2024-09-08