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

Objective. The objective of this study is to assess effects of clinicopathologic risk factors and contemporary therapeutic interventions on high-risk uterine epithelial carcinoma outcomes. Methods. Patient-, 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. Results. From 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. Conclusions. When 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. (C) 2013 Elsevier Inc. All rights reserved.