Uterine Cancer pp 105-141 | Cite as

Prognostic Factors in Uterine Cancer

  • Patricia M. Baker
  • Esther OlivaEmail author
Part of the Current Clinical Oncology book series (CCO)


Pathologic staging determines the management of patients with endo­metrial adenocarcinoma and uterine sarcomas following the initial surgery and it is an essential component of the initial assessment. FIGO stage, tumor subtype, grade of differentiation, myometrial invasion, lymphovascular invasion, and other factors that guide the treatment decisions covered in the subsequent chapters are extensively discussed.


Stage Myometrial invasion Differentiation Histologic subtype Lymphovascular invasion 


  1. 1.
    Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. Lancet 2005;366:491–505.PubMedGoogle Scholar
  2. 2.
    Sartori E, Laface B, Gadducci A, et al Factors influencing survival in endometrial cancer relapsing patients: a Cooperation Task Force (CTF) study. Int J Gynecol Cancer 2003;13:458–465.PubMedGoogle Scholar
  3. 3.
    Zaino RJ, Kurman RJ, Diana KL, Morrow CP. Pathologic models to predict outcome for women with endometrial adenocarcinoma: the importance of the distinction between surgical stage and clinical stage – a Gynecologic Oncology Group study. Cancer 1996;77:1115–1121.PubMedGoogle Scholar
  4. 5.
    Creasman WT, Odicino F, Maisonneuve P, et al Carcinoma of the corpus uteri. J Epidemiol Biostat 2001;6:47–86.PubMedGoogle Scholar
  5. 6.
    Fanning J, Alvarez PM, Tsukada Y, Piver MS. Prognostic significance of the extent of cervical involvement by endometrial cancer. Gynecol Oncol 1991;40:46–47.PubMedGoogle Scholar
  6. 7.
    Soothill PW, Alcock CJ, MacKenzie IZ. Discrepancy between curettage and hysterec­tomy histology in patients with stage 1 uterine malignancy. Br J Obstet Gynaecol 1989;96:478–481.PubMedGoogle Scholar
  7. 8.
    Cowles TA, Magriña JF, Masterson BJ, Capen CV. Comparison of clinical and surgical staging in patients with endometrial carcinoma. Obstet Gynecol 1985;66:413–416.PubMedGoogle Scholar
  8. 9.
    Chen SS. Extrauterine spread in endometrial carcinoma clinically confined to the uterus. Gynecol Oncol 1985;21:23–31.PubMedGoogle Scholar
  9. 10.
    Wolfson AH, Sightler SE, Markoe AM, et al. The prognostic significance of surgical staging for carcinoma of the endometrium. Gynecol Oncol 1992;45:142–146.PubMedGoogle Scholar
  10. 11.
    Steiner E, Eicher O, Sagemuller J, et al. Multivariate independent prognostic factors in endometrial carcinoma: a clinicopathologic study in 181 patients: 10 years experience at the Department of Obstetrics and Gynecology of the Mainz University. Int J Gynecol Cancer 2003;13:197–203.PubMedGoogle Scholar
  11. 12.
    Abeler VM, Kjorstad KE. Endometrial adenocarcinoma in Norway. A study of a total population. Cancer 1991;67:3093–3103.PubMedGoogle Scholar
  12. 13.
    Gal D, Recio FO, Zamurovic D. The New International Federation of Gynecology and Obstetrics surgical staging and survival rates in early endometrial carcinoma. Cancer 1992;69:200–202.PubMedGoogle Scholar
  13. 14.
    Kosary CL. FIGO stage, histology, histologic grade, age and race as prognostic factors in determining survival for cancers of the female gynecological system: an analysis of 1973–87 SEER cases of cancers of the endometrium, cervix, ovary, vulva, and vagina. Semin Surg Oncol 1994;10:31–46.PubMedGoogle Scholar
  14. 15.
    Abeler VM, Vergote IB, Kjorstad KE, Trope CG. Clear cell carcinoma of the endometrium. Prognosis and metastatic pattern. Cancer 1996;78:1740–1747.PubMedGoogle Scholar
  15. 16.
    Al Kushi A, Lim P, Aquino-Parsons C, Gilks CB. Markers of proliferative activity are predictors of patient outcome for low-grade endometrioid adenocarcinoma but not papillary serous carcinoma of endometrium. Mod Pathol 2002;15:365–371.PubMedGoogle Scholar
  16. 17.
    Morrow CP, Bundy BN, Kurman RJ, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol 1991;40:55–65.PubMedGoogle Scholar
  17. 18.
    DiSaia PJ, Creasman WT, Boronow RC, Blessing JA. Risk factors and recurrent patterns in Stage I endometrial cancer. Am J Obstet Gynecol 1985;151:1009–1015.PubMedGoogle Scholar
  18. 19.
    Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 1987;60:2035–2041.PubMedGoogle Scholar
  19. 20.
    Nielsen AL, Thomsen HK, Nyholm HC. Evaluation of the reproducibility of the revised 1988 International Federation of Gynecology and Obstetrics grading system of endometrial cancers with special emphasis on nuclear grading. Cancer 1991;68:2303–2309.PubMedGoogle Scholar
  20. 21.
    Mittal KR, Schwartz PE, Barwick KW. Architectural (FIGO) grading, nuclear grading, and other prognostic indicators in stage I endometrial adenocarcinoma with identification of high-risk and low-risk groups. Cancer 1988;61:538–545.PubMedGoogle Scholar
  21. 22.
    Stefansson IM, Salvesen HB, Immervoll H, Akslen LA. Prognostic impact of histological grade and vascular invasion compared with tumour cell proliferation in endometrial carcinoma of endometrioid type. Histopathology 2004;44:472–479.PubMedGoogle Scholar
  22. 23.
    Boronow RC, Morrow CP, Creasman WT, et al Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol 1984;63:825–832.PubMedGoogle Scholar
  23. 24.
    Lee KR, Vacek PM, Belinson JL. Traditional and nontraditional histopathologic predictors of recurrence in uterine endometrioid adenocarcinoma. Gynecol Oncol 1994;54:10–18.PubMedGoogle Scholar
  24. 25.
    Grigsby PW, Perez CA, Kuten A, et al. Clinical stage I endometrial cancer: prognostic factors for local control and distant metastasis and implications of the new FIGO surgical staging system. Int J Radiat Oncol Biol Phys 1992;22:905–911.PubMedGoogle Scholar
  25. 26.
    Abeler VM, Kjorstad KE, Berle E. Carcinoma of the endometrium in Norway: a histopathological and prognostic survey of a total population. Int J Gynecol Cancer 1992;2:9–22.PubMedGoogle Scholar
  26. 27.
    Konski A, Domenico D, Tyrkus M, et al. Prognostic characteristics of surgical stage I endometrial adenocarcinoma. Int J Radiat Oncol Biol Phys 1996;35:935–940.PubMedGoogle Scholar
  27. 28.
    Alektiar KM, McKee A, Lin O, et al. Is there a difference in outcome between stage I-II endometrial cancer of papillary serous/clear cell and endometrioid FIGO Grade 3 cancer? Int J Radiat Oncol Biol Phys 2002;54:79–85.PubMedGoogle Scholar
  28. 29.
    Lax SF, Kurman RJ, Pizer ES, Wu L, Ronnett BM. A binary architectural grading system for uterine endometrial endometrioid carcinoma has superior reproducibility compared with FIGO grading and identifies subsets of advance-stage tumors with favorable and unfavorable prognosis. Am J Surg Pathol 2000;24:1201–1208.PubMedGoogle Scholar
  29. 30.
    Alkushi A, Abdul-Rahman ZH, Lim P, et al. Description of a novel system for grading of endometrial carcinoma and comparison with existing grading systems. Am J Surg Pathol 2005;29:295–304.PubMedGoogle Scholar
  30. 31.
    Zaino RJ, Kurman R, Herbold D, et al. The significance of squamous differentiation in endometrial carcinoma. Data from a Gynecologic Oncology Group study. Cancer 1991;68:2293–2302.PubMedGoogle Scholar
  31. 32.
    Bockhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 1983;15:10–17.Google Scholar
  32. 33.
    Prat J. Prognostic parameters of endometrial carcinoma. Hum Pathol 2004;35:649–662.PubMedGoogle Scholar
  33. 34.
    Abeler VM, Kjorstad KE. Endometrial adenocarcinoma with squamous cell differentiation. Cancer 1992;69:488–495.PubMedGoogle Scholar
  34. 35.
    Longacre TA, Hendrickson MR. Diffusely infiltrative endometrial adenocarcinoma: an adenoma malignum pattern of myoinvasion. Am J Surg Pathol 1999;23:69–78.PubMedGoogle Scholar
  35. 36.
    Mittal KR, Barwick KW. Diffusely infiltrating adenocarcinoma of the endometrium. A subtype with poor prognosis. Am J Surg Pathol 1988;12:754–758.PubMedGoogle Scholar
  36. 37.
    Landry D, Mai KT, Senterman MK, et al. Endometrioid adenocarcinoma of the uterus with a minimal deviation invasive pattern. Histopathology 2003;42:77–82.PubMedGoogle Scholar
  37. 38.
    Ambros RA, Ballouk F, Malfetano JH, Ross JS. Significance of papillary (villoglandular) differentiation in endometrioid carcinoma of the uterus. Am J Surg Pathol 1994;18:569–575.PubMedGoogle Scholar
  38. 39.
    Esteller M, Garcia A, Martinez-Palones JM, Xercavins J, Reventos J. Clinicopathologic features and genetic alterations in endometrioid carcinoma of the uterus with villoglandular differentiation. Am J Clin Pathol 1999;111:336–342.PubMedGoogle Scholar
  39. 40.
    Ross JC, Eifel PJ, Cox RS, Kempson RL, Hendrickson MR. Primary mucinous adenocarcinoma of the endometrium. A clinicopathologic and histochemical study. Am J Surg Pathol 1983;7:715–729.PubMedGoogle Scholar
  40. 41.
    McCluggage WG, Sumathi VP, McManus DT. Uterine serous carcinoma and endometrial intraepithelial carcinoma arising in endometrial polyps: report of 5 cases, including 2 associated with tamoxifen therapy. Hum Pathol 2003;34:939–943.PubMedGoogle Scholar
  41. 42.
    Soslow RA, Pirog E, Isacson C. Endometrial intraepithelial carcinoma with associated peritoneal carcinomatosis. Am J Surg Pathol 2000;24:726–732.PubMedGoogle Scholar
  42. 43.
    Lauchlan SC. Tubal (serous) carcinoma of the endometrium. Arch Pathol Lab Med 1981;105:615–618.PubMedGoogle Scholar
  43. 44.
    Hendrickson M, Ross J, Eifel P, Martinez A, Kempson R. Uterine papillary serous carcinoma: a highly malignant form of endometrial adenocarcinoma. Am J Surg Pathol 1982;6:93–108.PubMedGoogle Scholar
  44. 45.
    Goff BA, Kato D, Schmidt RA, et al. Uterine papillary serous carcinoma: patterns of metastatic spread. Gynecol Oncol 1994;54:264–268.PubMedGoogle Scholar
  45. 46.
    Chambers JT, Merino M, Kohorn EI, Peschel RE, Schwartz PE. Uterine papillary serous carcinoma. Obstet Gynecol 1987;69:109–113.PubMedGoogle Scholar
  46. 47.
    Prat J, Oliva E, Lerma E, Vaquero M, Matias-Guiu X. Uterine papillary serous adenocarcinoma. A 10-case study of p53 and c-erbB-2 expression and DNA content. Cancer 1994;74:1778–1783.PubMedGoogle Scholar
  47. 48.
    Lax SF, Kendall B, Tashiro H, Slebos RJ, Hedrick L. The frequency of p53, K-ras mutations, and microsatellite instability differs in uterine endometrioid and serous carcinoma: evidence of distinct molecular genetic pathways. Cancer 2000;88:814–824.PubMedGoogle Scholar
  48. 49.
    Hamilton CA, Cheung MK, Osann K, et al. Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers. Br J Cancer 2006;94:642–646.PubMedGoogle Scholar
  49. 50.
    Carcangiu ML, Chambers JT. Uterine papillary serous carcinoma: a study on 108 cases with emphasis on the prognostic significance of associated endometrioid carcinoma, absence of invasion, and concomitant ovarian carcinoma. Gynecol Oncol 1992;47:298–305.PubMedGoogle Scholar
  50. 51.
    Hui P, Kelly M, O’Malley DM, Tavassoli F, Schwartz PE. Minimal uterine serous carcinoma: a clinicopathological study of 40 cases. Mod Pathol 2005;18:75–82.PubMedGoogle Scholar
  51. 52.
    Chan JK, Loizzi V, Youssef M, et al. Significance of comprehensive surgical staging in noninvasive papillary serous carcinoma of the endometrium. Gynecol Oncol 2003;90:181–185.PubMedGoogle Scholar
  52. 53.
    Matias-Guiu X, Catasus L, Bussaglia E, et al. Molecular pathology of endometrial hyperplasia and carcinoma. Hum Pathol 2001;32:569–577.PubMedGoogle Scholar
  53. 54.
    Catasus L, Machin P, Matias-Guiu X, Prat J. Microsatellite instability in endometrial carcinomas: clinicopathologic correlations in a series of 42 cases. Hum Pathol 1998;29:1160–1164.PubMedGoogle Scholar
  54. 55.
    Carcangiu ML, Chambers JT. Early pathologic stage clear cell carcinoma and uterine papillary serous carcinoma of the endometrium: comparison of clinicopathologic features and survival. Int J Gynecol Pathol 1995;14:30–38.PubMedGoogle Scholar
  55. 56.
    Abeler VM, Kjorstad KE. Clear cell carcinoma of the endometrium: a histopathological and clinical study of 97 cases. Gynecol Oncol 1991;40:207–217.PubMedGoogle Scholar
  56. 57.
    Goodman A, Zukerberg LR, Rice LW, Fuller AF, Young RH, Scully RE. Squamous cell carcinoma of the endometrium: a report of eight cases and a review of the literature. Gynecol Oncol 1996;61:54–60.PubMedGoogle Scholar
  57. 58.
    Lininger RA, Ashfaq R, Albores-Saavedra J, Tavassoli FA. Transitional cell carcinoma of the endometrium and endometrial carcinoma with transitional cell differentiation. Cancer 1997;79:1933–1943.PubMedGoogle Scholar
  58. 59.
    Abeler VM, Kjorstad KE, Nesland JM. Undifferentiated carcinoma of the endometrium. A histopathologic and clinical study of 31 cases. Cancer 1991;68:98–105.PubMedGoogle Scholar
  59. 60.
    Huntsman DG, Clement PB, Gilks CB, Scully RE. Small-cell carcinoma of the endometrium. A clinicopathological study of sixteen cases. Am J Surg Pathol 1994;18:364–375.PubMedGoogle Scholar
  60. 62.
    Eifel PJ, Ross J, Hendrickson M, Cox RS, Kempson R, Martinez A. Adenocarcinoma of the endometrium. Analysis of 256 cases with disease limited to the uterine corpus: treatment comparisons. Cancer 1983;52:1026–1031.PubMedGoogle Scholar
  61. 63.
    Mariani A, Webb MJ, Keeney GL, Lesnick TG, Podratz KC. Surgical stage I endometrial cancer: predictors of distant failure and death. Gynecol Oncol 2002;87:274–280.PubMedGoogle Scholar
  62. 64.
    Longacre TA, Chung MH, Jensen DN, Hendrickson MR. Proposed criteria for the diagnosis of well-differentiated endometrial carcinoma. A diagnostic test for myoinvasion. Am J Surg Pathol 1995;19:371–406.PubMedGoogle Scholar
  63. 65.
    Jacques SM, Lawrence WD. Endometrial adenocarcinoma with variable-level myometrial involvement limited to adenomyosis: a clinicopathologic study of 23 cases. Gynecol Oncol 1990;37:401–407.PubMedGoogle Scholar
  64. 66.
    Hall JB, Young RH, Nelson JH, Jr. The prognostic significance of adenomyosis in endometrial carcinoma. Gynecol Oncol 1984;17:32–40.PubMedGoogle Scholar
  65. 67.
    Mittal KR, Barwick KW. Endometrial adenocarcinoma involving adenomyosis without true myometrial invasion is characterized by frequent preceding estrogen therapy, low histologic grades, and excellent prognosis. Gynecol Oncol 1993;49:197–201.PubMedGoogle Scholar
  66. 68.
    Lindauer J, Fowler JM, Manolitsas TP, et al Is there a prognostic difference between depth of myometrial invasion and the tumor-free distance from the uterine serosa in endometrial cancer? Gynecol Oncol 2003;91:547–551.PubMedGoogle Scholar
  67. 69.
    Gemer O, Uriev L, Harkovsky T, et al. The significance of the degree of myometrial invasion in patients with stage IB endometrial cancer. Eur J Gynaecol Oncol 2004;25:336–338.PubMedGoogle Scholar
  68. 70.
    Zaino RJ. Conventional and novel prognostic factors in endometrial and adenocarcinoma: a critical appraisal. Pathol Case Reviews 2000;5:138–152.Google Scholar
  69. 71.
    Shim JU, Rose PG, Reale FR, Soto H, Tak WK, Hunter RE. Accuracy of frozen-section diagnosis at surgery in clinical stage I and II endometrial carcinoma. Am J Obstet Gynecol 1992;166:1335–1338.PubMedGoogle Scholar
  70. 72.
    Fanning J, Tsukada Y, Piver MS. Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 1990;37:47–50.PubMedGoogle Scholar
  71. 73.
    Goff BA, Rice LW. Assessment of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 1990;38:46–48.PubMedGoogle Scholar
  72. 74.
    Doering DL, Barnhill DR, Weiser EB, Burke TW, Woodward JE, Park RC. Intraoperative evaluation of depth of myometrial invasion in stage I endometrial adenocarcinoma. Obstet Gynecol 1989;74:930–933.PubMedGoogle Scholar
  73. 75.
    Gemer O, Uriev L, Harkovsky T, et al. Significance of lower uterine segment involvement in women with stage I endometrial adenocarcinoma. J Reprod Med 2004;49:703–706.PubMedGoogle Scholar
  74. 76.
    Kadar NR, Kohorn EI, LiVolsi VA, Kapp DS. Histologic variants of cervical involvement by endometrial carcinoma. Obstet Gynecol 1982;59:85–92.PubMedGoogle Scholar
  75. 77.
    Leminen A, Forss M, Lehtovirta P. Endometrial adenocarcinoma with clinical evidence of cervical involvement: accuracy of diagnostic procedures, clinical course, and prognostic factors. Acta Obstet Gynecol Scand 1995;74:61–66.PubMedGoogle Scholar
  76. 78.
    Weiner J, Bigelow B, Demopoulos RI, Beckman EM, Weiner I. The value of endocervical sampling in the staging of endometrial carcinoma. Diagn Gynecol Obstet 1980;2:265–268.PubMedGoogle Scholar
  77. 79.
    Jordan LB, Al-Nafussi A. Clinicopathological study of the pattern and significance of cervical involvement in cases of endometrial adenocarcinoma. Int J Gynecol Cancer 2002;12:42–48.PubMedGoogle Scholar
  78. 80.
    Eltabbakh GH, Moore AD. Survival of women with surgical stage II endometrial cancer. Gynecol Oncol 1999;74:80–85.PubMedGoogle Scholar
  79. 81.
    Alektiar KM, Venkatraman E, Abu-Rustum N, Barakat RR. Is endometrial carcinoma intrinsically more aggressive in elderly patients? Cancer 2003;98:2368–2377.PubMedGoogle Scholar
  80. 82.
    Menczer J. Management of endometrial carcinoma with cervical involvement. An unsettled issue. Eur J Gynaecol Oncol 2005;26:245–255.PubMedGoogle Scholar
  81. 83.
    Tambouret R, Clement PB, Young RH. Endometrial endometrioid adenocarcinoma with a deceptive pattern of spread to the uterine cervix: a manifestation of stage IIb endometrial carcinoma liable to be misinterpreted as an independent carcinoma or a benign lesion. Am J Surg Pathol 2003;27:1080–1088.PubMedGoogle Scholar
  82. 84.
    Creutzberg CL, van Putten WL, Koper PC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post operative radiation therapy in endometrial carcinoma. Lancet 2000;355:1404–1411.PubMedGoogle Scholar
  83. 85.
    Kennedy AW, Webster KD, Nuñez C, Bauer LJ. Pelvic washings for cytologic analysis in endometrial adenocarcinoma. J Reprod Med 1993;38:637–642.PubMedGoogle Scholar
  84. 86.
    Mundt AJ, Waggoner S, Yamada D, Rotmensch J, Connell PP. Age as a prognostic factor for recurrence in patients with endometrial carcinoma. Gynecol Oncol 2000;79:79–85.PubMedGoogle Scholar
  85. 87.
    Pitson G, Colgan T, Levin W, et al. Stage II endometrial carcinoma: prognostic factors and risk classification in 170 patients. Int J Radiat Oncol Biol Phys 2002;53:862–867.PubMedGoogle Scholar
  86. 88.
    Beckner ME, Mori T, Silverberg SG. Endometrial carcinoma: nontumor factors in prognosis. Int J Gynecol Pathol 1985;4:131–145.PubMedGoogle Scholar
  87. 89.
    Farley JH, Nycum LR, Birrer MJ, Park RC, Taylor RR. Age-specific survival of women with endometrioid adenocarcinoma of the uterus. Gynecol Oncol 2000;79:86–89.PubMedGoogle Scholar
  88. 90.
    Yamazawa K, Seki K, Matsui H, Sekiya S. Significance of perivascular lymphocytic infiltrates in endometrial carcinoma. Cancer 2001;91:1777–1784.PubMedGoogle Scholar
  89. 91.
    Briet JM, Hollema H, Reesink N, et al. Lymphvascular space involvement: an independent prognostic factor in endometrial cancer. Gynecol Oncol 2005;96:799–804.PubMedGoogle Scholar
  90. 92.
    Cohn DE, Horowitz NS, Mutch DG, Kim SM, Manolitsas T, Fowler JM. Should the presence of lymphvascular space involvement be used to assign patients to adjuvant therapy following hysterectomy for unstaged endometrial cancer? Gynecol Oncol 2002;87:243–246.PubMedGoogle Scholar
  91. 93.
    Ambros RA, Kurman RJ. Combined assessment of vascular and myometrial invasion as a model to predict prognosis in stage I endometrioid adenocarcinoma of the uterine corpus. Cancer 1992;69:1424–1431.PubMedGoogle Scholar
  92. 94.
    Hanson MB, van Nagell JR, Jr., Powell DE, et al The prognostic significance of lymph-vascular space invasion in stage I endometrial cancer. Cancer 1985;55:1753–1757.PubMedGoogle Scholar
  93. 95.
    Kadar N, Homesley HD, Malfetano JH. Positive peritoneal cytology is an adverse factor in endometrial carcinoma only if there is other evidence of extrauterine disease. Gynecol Oncol 1992;46:145–149.PubMedGoogle Scholar
  94. 96.
    Shah C, Johnson EB, Everett E, et al. Does size matter? Tumor size and morphology as predictors of nodal status and recurrence in endometrial cancer. Gynecol Oncol 2005;99:564–570.PubMedGoogle Scholar
  95. 97.
    Sivridis E, Buckley CH, Fox H. The prognostic significance of lymphatic vascular space invasion in endometrial adenocarcinoma. Br J Obstet Gynaecol 1987;94:991–994.PubMedGoogle Scholar
  96. 98.
    Gal D, Recio FO, Zamurovic D, Tancer ML. Lymphvascular space involvement – a prognostic indicator in endometrial adenocarcinoma. Gynecol Oncol 1991;42:142–145.PubMedGoogle Scholar
  97. 99.
    Watari H, Todo Y, Takeda M, Ebina Y, Yamamoto R, Sakuragi N. Lymph-vascular space invasion and number of positive para-aortic node groups predict survival in node-positive patients with endometrial cancer. Gynecol Oncol 2005;96:651–657.PubMedGoogle Scholar
  98. 100.
    Deligdisch L. Morphologic correlates of host response in endometrial carcinoma. Am J Reprod Immunol 1982;2:54–57.PubMedGoogle Scholar
  99. 101.
    Wong FC, Pang CP, Tang SK, et al Treatment results of endometrial carcinoma with positive peritoneal washing, adnexal involvement and serosal involvement. Clin Oncol (R Coll Radiol) 2004;16:350–355.Google Scholar
  100. 102.
    Connell PP, Rotmensch J, Waggoner S, Mundt AJ. The significance of adnexal involvement in endometrial carcinoma. Gynecol Oncol 1999;74:74–79.PubMedGoogle Scholar
  101. 103.
    Ulbright TM, Roth LM. Metastatic and independent cancers of the endometrium and ovary: a clinicopathologic study of 34 cases. Hum Pathol 1985;16:28–34.PubMedGoogle Scholar
  102. 104.
    Sutton GP. The significance of positive peritoneal cytology in endometrial cancer. Oncology (Williston Park) 1990;4:21–26; discussion 30–22.Google Scholar
  103. 105.
    Takeshima N, Nishida H, Tabata T, Hirai Y, Hasumi K. Positive peritoneal cytology in endometrial cancer: enhancement of other prognostic indicators. Gynecol Oncol 2001;82:470–473.PubMedGoogle Scholar
  104. 106.
    Schorge JO, Molpus KL, Goodman A, Nikrui N, Fuller AF, Jr. The effect of postsurgical therapy on stage III endometrial carcinoma. Gynecol Oncol 1996;63:34–39.PubMedGoogle Scholar
  105. 107.
    Greven KM, Lanciano RM, Corn B, Case D, Randall ME. Pathologic stage III endometrial carcinoma. Prognostic factors and patterns of recurrence. Cancer 1993;71:3697–3702.PubMedGoogle Scholar
  106. 108.
    Takeshima N, Hirai Y, Yano K, Tanaka N, Yamauchi K, Hasumi K. Ovarian metastasis in endometrial carcinoma. Gynecol Oncol 1998;70:183–187.PubMedGoogle Scholar
  107. 109.
    Ashman JB, Connell PP, Yamada D, Rotmensch J, Waggoner SE, Mundt AJ. Outcome of endometrial carcinoma patients with involvement of the uterine serosa. Gynecol Oncol 2001;82:338–343.PubMedGoogle Scholar
  108. 110.
    Grigsby PW, Perez CA, Kuske RR, Kao MS, Galakatos AE. Results of therapy, analysis of failures, and prognostic factors for clinical and pathologic stage III adenocarcinoma of the endometrium. Gynecol Oncol 1987;27:44–57.PubMedGoogle Scholar
  109. 111.
    Lurain JR. The significance of positive peritoneal cytology in endometrial cancer. Gynecol Oncol 1992;46:143–144.PubMedGoogle Scholar
  110. 112.
    Mariani A, Webb MJ, Keeney GL, Aletti G, Podratz KC. Assessment of prognostic factors in stage IIIA endometrial cancer. Gynecol Oncol 2002;86:38–44.PubMedGoogle Scholar
  111. 113.
    Kashimura M, Sugihara K, Toki N, et al The significance of peritoneal cytology in uterine cervix and endometrial cancer. Gynecol Oncol 1997;67:285–290.PubMedGoogle Scholar
  112. 114.
    Kasamatsu T, Onda T, Katsumata N, et al. Prognostic significance of positive peritoneal cytology in endometrial carcinoma confined to the uterus. Br J Cancer 2003;88:245–250.PubMedGoogle Scholar
  113. 115.
    Tebeu PM, Popowski Y, Verkooijen HM, et al. Positive peritoneal cytology in early-stage endometrial cancer does not influence prognosis. Br J Cancer 2004;91:720–724.PubMedGoogle Scholar
  114. 116.
    Grimshaw RN, Tupper WC, Fraser RC, Tompkins MG, Jeffrey JF. Prognostic value of peritoneal cytology in endometrial carcinoma. Gynecol Oncol 1990;36:97–100.PubMedGoogle Scholar
  115. 117.
    Ayhan A, Taskiran C, Celik C, Aksu T, Yuce K. Surgical stage III endometrial cancer: analysis of treatment outcomes, prognostic factors and failure patterns. Eur J Gynaecol Oncol 2002;23:553–556.PubMedGoogle Scholar
  116. 118.
    Turner DA, Gershenson DM, Atkinson N, Sneige N, Wharton AT. The prognostic significance of peritoneal cytology for stage I endometrial cancer. Obstet Gynecol 1989;74:775–780.PubMedGoogle Scholar
  117. 119.
    Santala M, Talvensaari-Mattila A, Kauppila A. Peritoneal cytology and preoperative serum CA 125 level are important prognostic indicators of overall survival in advanced endometrial cancer. Anticancer Res 2003;23:3097–3103.PubMedGoogle Scholar
  118. 120.
    Mlyncek M, Uharcek P. Peritoneal cytology in endometrial cancer. Neoplasma 2005;52:103–108.PubMedGoogle Scholar
  119. 121.
    Lampe B, Kurzl R, Hantschmann P. Prognostic factors that predict pelvic lymph node metastasis from endometrial carcinoma. Cancer 1994;74:2502–2508.PubMedGoogle Scholar
  120. 122.
    Ohkouchi T, Sakuragi N, Watari H, et al Prognostic significance of Bcl-2, p53 overexpression, and lymph node metastasis in surgically staged endometrial carcinoma. Am J Obstet Gynecol 2002;187:353–359.PubMedGoogle Scholar
  121. 123.
    Chuang L, Burke TW, Tornos C, et al. Staging laparotomy for endometrial carcinoma: assessment of retroperitoneal lymph nodes. Gynecol Oncol 1995;58:189–193.PubMedGoogle Scholar
  122. 124.
    Kilgore LC, Partridge EE, Alvarez RD, et al. Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol 1995;56:29–33.PubMedGoogle Scholar
  123. 125.
    Larson DM, Johnson KK. Pelvic and para-aortic lymphadenectomy for surgical staging of high-risk endometrioid adenocarcinoma of the endometrium. Gynecol Oncol 1993;51:345–348.PubMedGoogle Scholar
  124. 126.
    Yokoyama Y, Maruyama H, Sato S, Saito Y. Indispensability of pelvic and paraaortic lymphadenectomy in endometrial cancers. Gynecol Oncol 1997;64:411–417.PubMedGoogle Scholar
  125. 127.
    Arango HA, Hoffman MS, Roberts WS, DeCesare SL, Fiorica JV, Drake J. Accuracy of lymph node palpation to determine need for lymphadenectomy in gynecologic malignancies. Obstet Gynecol 2000;95:553–556.PubMedGoogle Scholar
  126. 128.
    Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol 2000;182:1506–1519.PubMedGoogle Scholar
  127. 129.
    Mariani A, Keeney GL, Aletti G, Webb MJ, Haddock MG, Podratz KC. Endometrial carcinoma: paraaortic dissemination. Gynecol Oncol 2004;92:833–838.PubMedGoogle Scholar
  128. 130.
    McMeekin DS, Lashbrook D, Gold M, Johnson G, Walker JL, Mannel R. Analysis of FIGO Stage IIIc endometrial cancer patients. Gynecol Oncol 2001;81:273–278.PubMedGoogle Scholar
  129. 131.
    Mohan DS, Samuels MA, Selim MA, et al Long-term outcomes of therapeutic pelvic lymphadenectomy for stage I endometrial adenocarcinoma. Gynecol Oncol 1998;70:165–171.PubMedGoogle Scholar
  130. 132.
    Lutman CV, Havrilesky LJ, Cragun JM, et al Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol 2006;102:92–97.PubMedGoogle Scholar
  131. 133.
    Girardi F, Petru E, Heydarfadai M, Haas J, Winter R. Pelvic lymphadenectomy in the surgical treatment of endometrial cancer. Gynecol Oncol 1993;49:177–180.PubMedGoogle Scholar
  132. 134.
    Yabushita H, Shimazu M, Yamada H, et al Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in node-negative endometrial cancer. Gynecol Oncol 2001;80:139–144.PubMedGoogle Scholar
  133. 135.
    Gonzalez Bosquet J, Keeney GL, Mariani A, Webb MJ, Cliby WA. Cytokeratin staining of resected lymph nodes may improve the sensitivity of surgical staging for endometrial cancer. Gynecol Oncol 2003;91:518–525.PubMedGoogle Scholar
  134. 136.
    Bats AS, Clement D, Larousserie F, et al Is sentinel node biopsy feasible in endometrial cancer? Results in 26 patients. J Gynecol Obstet Biol Reprod (Paris) 2005;34:768–774.Google Scholar
  135. 137.
    Evans MP, Podratz KC. Endometrial neoplasia: prognostic significance of ploidy status. Clin Obstet Gynecol 1996;39:696–706.PubMedGoogle Scholar
  136. 138.
    Britton LC, Wilson TO, Gaffey TA, Lieber MM, Wieand HS, Podratz KC. Flow cytometric DNA analysis of stage I endometrial carcinoma. Gynecol Oncol 1989;34:317–322.PubMedGoogle Scholar
  137. 139.
    Santala M, Talvensaari-Mattila A. DNA ploidy is an independent prognostic indicator of overall survival in stage I endometrial endometrioid carcinoma. Anticancer Res 2003;23:5191–5196.PubMedGoogle Scholar
  138. 140.
    Lundgren C, Auer G, Frankendal B, Moberger B, Nilsson B, Nordstrom B. Nuclear DNA content, proliferative activity, and p53 expression related to clinical and histopathologic features in endometrial carcinoma. Int J Gynecol Cancer 2002;12:110–118.PubMedGoogle Scholar
  139. 141.
    Genest DR, Sheets E, Lage JM. Flow-cytometric analysis of nuclear DNA content in endometrial adenocarcinoma. Atypical mitoses are associated with DNA aneuploidy. Am J Clin Pathol 1994;102:341–348.PubMedGoogle Scholar
  140. 142.
    Mangili G, De Marzi P, Vigano R, et al Identification of high risk patients with endometrial carcinoma. Prognostic assessment of endometrial cancer. Eur J Gynaecol Oncol 2002;23:216–220.PubMedGoogle Scholar
  141. 143.
    Lukes AS, Kohler MF, Pieper CF, et al. Multivariable analysis of DNA ploidy, p53, and HER-2/neu as prognostic factors in endometrial cancer. Cancer 1994;73:2380–2385.PubMedGoogle Scholar
  142. 144.
    Pfisterer J, Kommoss F, Sauerbrei W, et al. Prognostic value of DNA ploidy and S-phase fraction in stage I endometrial carcinoma. Gynecol Oncol 1995;58:149–156.PubMedGoogle Scholar
  143. 145.
    Geisinger KR, Homesley HD, Morgan TM, Kute TE, Marshall RB. Endometrial adenocarcinoma. A multiparameter clinicopathologic analysis including the DNA profile and the sex steroid hormone receptors. Cancer 1986;58:1518–1525.PubMedGoogle Scholar
  144. 146.
    Sorbe B, Risberg B, Frankendal B. DNA ploidy, morphometry, and nuclear grade as prognostic factors in endometrial carcinoma. Gynecol Oncol 1990;38:22–27.PubMedGoogle Scholar
  145. 147.
    Carcangiu ML, Chambers JT. Sex steroid receptors in gynecologic neoplasms. Pathol Annu 1992;27(Pt 2):121–151.PubMedGoogle Scholar
  146. 148.
    Creasman WT. Prognostic significance of hormone receptors in endometrial cancer. Cancer 1993;71:1467–1470.PubMedGoogle Scholar
  147. 149.
    Chambers JT, MacLusky N, Eisenfield A, Kohorn EI, Lawrence R, Schwartz PE. Estrogen and progestin receptor levels as prognosticators for survival in endometrial cancer. Gynecol Oncol 1988;31:65–81.PubMedGoogle Scholar
  148. 150.
    Hanekamp EE, Gielen SC, Smid-Koopman E, et al. Consequences of loss of progesterone receptor expression in development of invasive endometrial cancer. Clin Cancer Res 2003;9:4190–4199.PubMedGoogle Scholar
  149. 151.
    Kadar N, Malfetano JH, Homesley HD. Steroid receptor concentrations in endometrial carcinoma: effect on survival in surgically staged patients. Gynecol Oncol 1993;50:281–286.PubMedGoogle Scholar
  150. 152.
    Morris PC, Anderson JR, Anderson B, Buller RE. Steroid hormone receptor content and lymph node status in endometrial cancer. Gynecol Oncol 1995;56:406–411.PubMedGoogle Scholar
  151. 153.
    Lax SF, Pizer ES, Ronnett BM, Kurman RJ. Clear cell carcinoma of the endometrium is characterized by a distinctive profile of p53, Ki-67, estrogen, and progesterone receptor expression. Hum Pathol 1998;29:551–558.PubMedGoogle Scholar
  152. 154.
    Carcangiu ML, Chambers JT, Voynick IM, Pirro M, Schwartz PE. Immunohistochemical evaluation of estrogen and progesterone receptor content in 183 patients with endometrial carcinoma. Part I: clinical and histologic correlations. Am J Clin Pathol 1990;94:247–254.PubMedGoogle Scholar
  153. 155.
    Arai T, Watanabe J, Kawaguchi M, et al. Clear cell adenocarcinoma of the endometrium is a biologically distinct entity from endometrioid adenocarcinoma. Int J Gynecol Cancer 2006;16:391–395.PubMedGoogle Scholar
  154. 156.
    Ehrlich CE, Young PC, Stehman FB, Sutton GP, Alford WM. Steroid receptors and clinical outcome in patients with adenocarcinoma of the endometrium. Am J Obstet Gynecol 1988;158:796–807.PubMedGoogle Scholar
  155. 157.
    Hu K, Zhong G, He F. Expression of estrogen receptors ERalpha and ERbeta in endometrial hyperplasia and adenocarcinoma. Int J Gynecol Cancer 2005;15:537–541.PubMedGoogle Scholar
  156. 158.
    De Vivo I, Huggins GS, Hankinson SE, et al. A functional polymorphism in the promoter of the progesterone receptor gene associated with endometrial cancer risk. Proc Natl Acad Sci U S A 2002;99:12263–12268.PubMedGoogle Scholar
  157. 159.
    Hetzel DJ, Wilson TO, Keeney GL, Roche PC, Cha SS, Podratz KC. HER-2/neu expression: a major prognostic factor in endometrial cancer. Gynecol Oncol 1992;47:179–185.PubMedGoogle Scholar
  158. 160.
    Santin AD. HER2/neu overexpression: has the Achilles’ heel of uterine serous papillary carcinoma been exposed? Gynecol Oncol 2003;88:263–265.PubMedGoogle Scholar
  159. 161.
    Saffari B, Jones LA, el-Naggar A, Felix JC, George J, Press MF. Amplification and overexpression of HER-2/neu (c-erbB2) in endometrial cancers: correlation with overall survival. Cancer Res 1995;55:5693–5698.PubMedGoogle Scholar
  160. 162.
    Berchuck A, Rodriguez G, Kinney RB, et al. Overexpression of HER-2/neu in endometrial cancer is associated with advanced stage disease. Am J Obstet Gynecol 1991;164:15–21.PubMedGoogle Scholar
  161. 163.
    Peiro G, Mayr D, Hillemanns P, Lohrs U, Diebold J. Analysis of HER-2/neu amplification in endometrial carcinoma by chromogenic in situ hybridization. Correlation with fluorescence in situ hybridization, HER-2/neu, p53 and Ki-67 protein expression, and outcome. Mod Pathol 2004;17:227–287.PubMedGoogle Scholar
  162. 164.
    Pisani AL, Barbuto DA, Chen D, Ramos L, Lagasse LD, Karlan BY. HER-2/neu, p53, and DNA analyses as prognosticators for survival in endometrial carcinoma. Obstet Gynecol 1995;85:729–734.PubMedGoogle Scholar
  163. 165.
    Riben MW, Malfetano JH, Nazeer T, Muraca PJ, Ambros RA, Ross JS. Identification of HER-2/neu oncogene amplification by fluorescence in situ hybridization in stage I endometrial carcinoma. Mod Pathol 1997;10:823–831.PubMedGoogle Scholar
  164. 166.
    Heffner HM, Freedman AN, Asirwatham JE, Lele SB. Prognostic significance of p53, PCNA, and c-erbB-2 in endometrial enocarcinoma. Eur J Gynaecol Oncol 1999;20:8–12.PubMedGoogle Scholar
  165. 167.
    Coronado PJ, Vidart JA, Lopez-Asenjo JA, et al. P53 overexpression predicts endometrial carcinoma recurrence better than HER-2/neu overexpression. Eur J Obstet Gynecol Reprod Biol 2001;98:103–108.PubMedGoogle Scholar
  166. 168.
    Williams JA, Jr., Wang ZR, Parrish RS, Hazlett LJ, Smith ST, Young SR. Fluorescence in situ hybridization analysis of HER-2/neu, c-myc, and p53 in endometrial cancer. Exp Mol Pathol 1999;67:135–143.PubMedGoogle Scholar
  167. 169.
    Rolitsky CD, Theil KS, McGaughy VR, Copeland LJ, Niemann TH. HER-2/neu amplification and overexpression in endometrial carcinoma. Int J Gynecol Pathol 1999;18:138–143.PubMedGoogle Scholar
  168. 170.
    Khalifa MA, Mannel RS, Haraway SD, Walker J, Min KW. Expression of EGFR, HER-2/neu, P53, and PCNA in endometrioid, serous papillary, and clear cell endometrial adenocarcinomas. Gynecol Oncol 1994;53:84–92.PubMedGoogle Scholar
  169. 171.
    Tashiro H, Isacson C, Levine R, Kurman RJ, Cho KR, Hedrick L. p53 gene mutations are common in uterine serous carcinoma and occur early in their pathogenesis. Am J Pathol 1997;150:177–185.PubMedGoogle Scholar
  170. 172.
    An HJ, Logani S, Isacson C, Ellenson LH. Molecular characterization of uterine clear cell carcinoma. Mod Pathol 2004;17:530–537.PubMedGoogle Scholar
  171. 173.
    Alkushi A, Lim P, Coldman A, Huntsman D, Miller D, Gilks CB. Interpretation of p53 immunoreactivity in endometrial carcinoma: establishing a clinically relevant cut-off level. Int J Gynecol Pathol 2004;23:129–137.PubMedGoogle Scholar
  172. 174.
    Geisler JP, Geisler HE, Wiemann MC, Zhou Z, Miller GA, Crabtree W. Lack of bcl-2 persistence: an independent prognostic indicator of poor prognosis in endometrial carcinoma. Gynecol Oncol 1998;71:305–307.PubMedGoogle Scholar
  173. 175.
    Taskin M, Lallas TA, Barber HR, Shevchuk MM. bcl-2 and p53 in endometrial adenocarcinoma. Mod Pathol 1997;10:728–734.PubMedGoogle Scholar
  174. 176.
    Zheng W, Cao P, Zheng M, Kramer EE, Godwin TA. p53 overexpression and bcl-2 persistence in endometrial carcinoma: comparison of papillary serous and endometrioid subtypes. Gynecol Oncol 1996;61:167–174.PubMedGoogle Scholar
  175. 177.
    Yamauchi N, Sakamoto A, Uozaki H, Iihara K, Machinami R. Immunohistochemical analysis of endometrial adenocarcinoma for bcl-2 and p53 in relation to expression of sex steroid receptor and proliferative activity. Int J Gynecol Pathol 1996;15:202–208.PubMedGoogle Scholar
  176. 178.
    Mariani A, Sebo TJ, Cliby WA, et al. Role of bcl-2 in endometrioid corpus cancer: an experimental study. Anticancer Res 2006;26:823–827.PubMedGoogle Scholar
  177. 179.
    Risinger JI, Hayes K, Maxwell GL, et al. PTEN mutation in endometrial cancers is associated with favorable clinical and pathologic characteristics. Clin Cancer Res 1998;4:3005–3010.PubMedGoogle Scholar
  178. 180.
    Tashiro H, Blazes MS, Wu R, et al. Mutations in PTEN are frequent in endometrial carcinoma but rare in other common gynecological malignancies. Cancer Res 1997;57:3935–3940.PubMedGoogle Scholar
  179. 181.
    Bussaglia E, del Rio E, Matias-Guiu X, Prat J. PTEN mutations in endometrial carcinomas: a molecular and clinicopathologic analysis of 38 cases. Hum Pathol 2000;31:312–317.PubMedGoogle Scholar
  180. 182.
    Levine RL, Cargile CB, Blazes MS, van Rees B, Kurman RJ, Ellenson LH. PTEN mutations and microsatellite instability in complex atypical hyperplasia, a precursor lesion to uterine endometrioid carcinoma. Cancer Res 1998;58:3254–3258.PubMedGoogle Scholar
  181. 183.
    Bilbao C, Rodriguez G, Ramirez R, et al. The relationship between microsatellite instability and PTEN gene mutations in endometrial cancer. Int J Cancer 2006;119:563–570.PubMedGoogle Scholar
  182. 184.
    Terakawa N, Kanamori Y, Yoshida S. Loss of PTEN expression followed by Akt phosphorylation is a poor prognostic factor for patients with endometrial cancer. Endocr Relat Cancer 2003;10:203–208.PubMedGoogle Scholar
  183. 185.
    Lagarda H, Catasus L, Arguelles R, Matias-Guiu X, Prat J. K-ras mutations in endometrial carcinomas with microsatellite instability. J Pathol 2001;193:193–199.PubMedGoogle Scholar
  184. 186.
    Duggan BD, Felix JC, Muderspach LI, Tsao JL, Shibata DK. Early mutational activation of the c-Ki-ras oncogene in endometrial carcinoma. Cancer Res 1994;54:1604–1607.PubMedGoogle Scholar
  185. 187.
    Mutter GL, Wada H, Faquin WC, Enomoto T. K-ras mutations appear in the premalignant phase of both microsatellite stable and unstable endometrial carcinogenesis. Mol Pathol 1999;52:257–262.PubMedGoogle Scholar
  186. 188.
    Caduff RF, Johnston CM, Frank TS. Mutations of the Ki-ras oncogene in carcinoma of the endometrium. Am J Pathol 1995;146:182–188.PubMedGoogle Scholar
  187. 189.
    Parc YR, Halling KC, Burgart LJ, et al. Microsatellite instability and hMLH1/hMSH2 expression in young endometrial carcinoma patients: associations with family history and histopathology. Int J Cancer 2000;86:60–66.PubMedGoogle Scholar
  188. 190.
    Maxwell GL, Risinger JI, Alvarez AA, Barrett JC, Berchuck A. Favorable survival associated with microsatellite instability in endometrioid endometrial cancers. Obstet Gynecol 2001;97:417–422.PubMedGoogle Scholar
  189. 191.
    Caduff RF, Johnston CM, Svoboda-Newman SM, Poy EL, Merajver SD, Frank TS. Clinical and pathological significance of microsatellite instability in sporadic endometrial carcinoma. Am J Pathol 1996;148:1671–1678.PubMedGoogle Scholar
  190. 192.
    Fiumicino S, Ercoli A, Ferrandina G, et al. Microsatellite instability is an independent indicator of recurrence in sporadic stage I–II endometrial adenocarcinoma. J Clin Oncol 2001;19:1008–1014.PubMedGoogle Scholar
  191. 193.
    Orbo A, Eklo K, Kopp M. A semiautomated test for microsatellite instability and its significance for the prognosis of sporadic endometrial cancer in northern Norway. Int J Gynecol Pathol 2002;21:27–33.PubMedGoogle Scholar
  192. 194.
    Kobayashi K, Sagae S, Kudo R, Saito H, Koi S, Nakamura Y. Microsatellite instability in endometrial carcinomas: frequent replication errors in tumors of early onset and/or of poorly differentiated type. Genes Chromosomes Cancer 1995;14:128–132.PubMedGoogle Scholar
  193. 195.
    Tibiletti MG, Furlan D, Taborelli M, et al. Microsatellite instability in endometrial cancer: relation to histological subtypes. Gynecol Oncol 1999;73:247–252.PubMedGoogle Scholar
  194. 196.
    Wong YF, Ip TY, Chung TK, et al. Clinical and pathologic significance of microsatellite instability in endometrial cancer. Int J Gynecol Cancer 1999;9:406–410.PubMedGoogle Scholar
  195. 197.
    MacDonald ND, Salvesen HB, Ryan A, Iversen OE, Akslen LA, Jacobs IJ. Frequency and prognostic impact of microsatellite instability in a large population-based study of endometrial carcinomas. Cancer Res 2000;60:1750–1752.PubMedGoogle Scholar
  196. 198.
    Machin P, Catasus L, Pons C, Muñoz J, Matias-Guiu X, Prat J. CTNNB1 mutations and beta-catenin expression in endometrial carcinomas. Hum Pathol 2002;33:206–212.PubMedGoogle Scholar
  197. 199.
    Moreno-Bueno G, Hardisson D, Sanchez C, et al. Abnormalities of the APC/beta-catenin pathway in endometrial cancer. Oncogene 2002;21:7981–7990.PubMedGoogle Scholar
  198. 200.
    Fukuchi T, Sakamoto M, Tsuda H, Maruyama K, Nozawa S, Hirohashi S. Beta-catenin mutation in carcinoma of the uterine endometrium. Cancer Res 1998;58:3526–3528.PubMedGoogle Scholar
  199. 201.
    Ikeda T, Yoshinaga K, Semba S, Kondo E, Ohmori H, Horii A. Mutational analysis of the CTNNB1 (beta-catenin) gene in human endometrial cancer: frequent mutations at codon 34 that cause nuclear accumulation. Oncol Rep 2000;7:323–326.PubMedGoogle Scholar
  200. 202.
    Saegusa M, Hashimura M, Yoshida T, Okayasu I. Beta-catenin mutations and aberrant nuclear expression during endometrial tumorigenesis. Br J Cancer 2001;84:209–217.PubMedGoogle Scholar
  201. 203.
    Giuntoli RL, Metzinger DS, DiMarco CS, et al. Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol 2003;89:460–469.PubMedGoogle Scholar
  202. 204.
    Bodner K, Bodner-Adler B, Kimberger O, Czerwenka K, Leodolter S, Mayerhofer K. Evaluating prognostic parameters in women with uterine leiomyosarcoma. A clinicopathologic study. J Reprod Med 2003;48:95–100.PubMedGoogle Scholar
  203. 205.
    Pautier P, Genestie C, Rey A, et al. Analysis of clinicopathologic prognostic factors for 157 uterine sarcomas and evaluation of a grading score validated for soft tissue sarcoma. Cancer 2000;88:1425–1431.PubMedGoogle Scholar
  204. 206.
    Jones MW, Norris HJ. Clinicopathologic study of 28 uterine leiomyosarcomas with metastasis. Int J Gynecol Pathol 1995;14:243–249.PubMedGoogle Scholar
  205. 207.
    Major FJ, Blessing JA, Silverberg SG, et al. Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer 1993;71:1702–1709.PubMedGoogle Scholar
  206. 208.
    Larson B, Silfversward C, Nilsson B, Pettersson F. Prognostic factors in uterine leiomyosarcoma. A clinical and histopathological study of 143 cases. The Radiumhemmet series 1936–1981. Acta Oncol 1990;29:185–191.PubMedGoogle Scholar
  207. 209.
    Dinh TA, Oliva EA, Fuller AF, Jr., Lee H, Goodman A. The treatment of uterine leiomyosarcoma. Results from a 10-year experience (1990–1999) at the Massachusetts General Hospital. Gynecol Oncol 2004;92:648–652.PubMedGoogle Scholar
  208. 210.
    Mayerhofer K, Obermair A, Windbichler G, et al. Leiomyosarcoma of the uterus: a clinicopathologic multicenter study of 71 cases. Gynecol Oncol 1999;74:196–201.PubMedGoogle Scholar
  209. 211.
    Hsieh CH, Lin H, Huang CC, Huang EY, Chang SY, Chang Chien CC. Leiomyosarcoma of the uterus: a clinicopathologic study of 21 cases. Acta Obstet Gynecol Scand 2003;82:74–81.PubMedGoogle Scholar
  210. 212.
    Evans HL, Chawla SP, Simpson C, Finn KP. Smooth muscle neoplasms of the uterus other than ordinary leiomyoma. A study of 46 cases, with emphasis on diagnostic criteria and prognostic factors. Cancer 1988;62:2239–2247.PubMedGoogle Scholar
  211. 213.
    Nordal RR, Kristensen GB, Kaern J, Stenwig AE, Pettersen EO, Trope CG. The prognostic significance of stage, tumor size, cellular atypia and DNA ploidy in uterine leiomyosarcoma. Acta Oncol 1995;34:797–802.PubMedGoogle Scholar
  212. 214.
    Leitao MM, Soslow RA, Nonaka D, et al. Tissue microarray immunohistochemical expression of estrogen, progesterone, and androgen receptors in uterine leiomyomata and leiomyosarcoma. Cancer 2004;101:1455–1462.PubMedGoogle Scholar
  213. 215.
    Kurman RJ, Norris HJ. Mesenchymal tumors of the uterus. VI. Epithelioid smooth muscle tumors including leiomyoblastoma and clear-cell leiomyoma: a clinical and pathologic analysis of 26 cases. Cancer 1976;37:1853–1865.PubMedGoogle Scholar
  214. 216.
    Prayson RA, Goldblum JR, Hart WR. Epithelioid smooth-muscle tumors of the uterus: a clinicopathologic study of 18 patients. Am J Surg Pathol 1997;21:383–391.PubMedGoogle Scholar
  215. 217.
    King ME, Dickersin GR, Scully RE. Myxoid leiomyosarcoma of the uterus. A report of six cases. Am J Surg Pathol 1982;6:589–598.PubMedGoogle Scholar
  216. 218.
    Raspollini MR, Amunni G, Villanucci A, et al. Estrogen and progesterone receptors expression in uterine malignant smooth muscle tumors: correlation with clinical outcome. J Chemother 2003;15:596–602.PubMedGoogle Scholar
  217. 219.
    Bodner K, Bodner-Adler B, Kimberger O, Czerwenka K, Leodolter S, Mayerhofer K. Estrogen and progesterone receptor expression in patients with uterine leiomyosarcoma and correlation with different clinicopathological parameters. Anticancer Res 2003;23:729–732.PubMedGoogle Scholar
  218. 220.
    Goff BA, Rice LW, Fleischhacker D, et al. Uterine leiomyosarcoma and endometrial stromal sarcoma: lymph node metastases and sites of recurrence. Gynecol Oncol 1993;50:105–109.PubMedGoogle Scholar
  219. 221.
    Leitao MM, Sonoda Y, Brennan MF, Barakat RR, Chi DS. Incidence of lymph node and ovarian metastases in leiomyosarcoma of the uterus. Gynecol Oncol 2003;91:209–212.PubMedGoogle Scholar
  220. 222.
    Blom R, Guerrieri C, Stal O, Malmstrom H, Simonsen E. Leiomyosarcoma of the uterus: a clinicopathologic, DNA flow cytometric, p53, and mdm-2 analysis of 49 cases. Gynecol Oncol 1998;68:54–61.PubMedGoogle Scholar
  221. 223.
    Lennart K, Lennart B, Ulf S, Bernard T. Flow cytometric analysis of uterine sarcomas. Gynecol Oncol 1994;55:339–342.PubMedGoogle Scholar
  222. 224.
    Amada S, Nakano H, Tsuneyoshi M. Leiomyosarcoma versus bizarre and cellular leiomyomas of the uterus: a comparative study based on the MIB-1 and proliferating cell nuclear antigen indices, p53 expression, DNA flow cytometry, and muscle specific actins. Int J Gynecol Pathol 1995;14:134–142.PubMedGoogle Scholar
  223. 225.
    Liu FS, Kohler MF, Marks JR, Bast RC, Jr., Boyd J, Berchuck A. Mutation and overexpression of the p53 tumor suppressor gene frequently occurs in uterine and ovarian sarcomas. Obstet Gynecol 1994;83:118–124.PubMedGoogle Scholar
  224. 226.
    Wang L, Felix JC, Lee JL, et al. The proto-oncogene c-kit is expressed in leiomyosarcomas of the uterus. Gynecol Oncol 2003;90:402–406.PubMedGoogle Scholar
  225. 227.
    Rushing RS, Shajahan S, Chendil D, et al Uterine sarcomas express KIT protein but lack mutation(s) in exon 11 or 17 of c-KIT. Gynecol Oncol 2003;91:9–14.PubMedGoogle Scholar
  226. 228.
    Winter WE, 3rd, Seidman JD, Krivak TC, et al. Clinicopathological analysis of c-kit expression in carcinosarcomas and leiomyosarcomas of the uterine corpus. Gynecol Oncol 2003;91:3–8.PubMedGoogle Scholar
  227. 229.
    Raspollini MR, Paglierani M, Taddei GL, Villanucci A, Amunni G, Taddei A. The protooncogene c-KIT is expressed in leiomyosarcomas of the uterus. Gynecol Oncol 2004;93:718.PubMedGoogle Scholar
  228. 230.
    Raspollini MR, Pinzani P, Simi L, et al. Uterine leiomyosarcomas express KIT protein but lack mutation(s) in exon 9 of c-KIT. Gynecol Oncol 2005;98:334–335.PubMedGoogle Scholar
  229. 231.
    Zaloudek CJ, Norris HJ. Adenofibroma and adenosarcoma of the uterus: a clinicopathologic study of 35 cases. Cancer 1981;48:354–366.PubMedGoogle Scholar
  230. 232.
    Clement PB, Scully RE. Mullerian adenofibroma of the uterus with invasion of myometrium and pelvic veins. Int J Gynecol Pathol 1990;9:363–371.PubMedGoogle Scholar
  231. 233.
    Kaku T, Silverberg SG, Major FJ, Miller A, Fetter B, Brady MF. Adenosarcoma of the uterus: a Gynecologic Oncology Group clinicopathologic study of 31 cases. Int J Gynecol Pathol 1992;11:75–88.PubMedGoogle Scholar
  232. 234.
    Clement PB. Mullerian adenosarcomas of the uterus with sarcomatous overgrowth. A clinicopathological analysis of 10 cases. Am J Surg Pathol 1989;13:28–38.PubMedGoogle Scholar
  233. 235.
    Chuang JT, Van Velden DJ, Graham JB. Carcinosarcoma and mixed mesodermal tumor of the uterine corpus. Review of 49 cases. Obstet Gynecol 1970;35:769–780.PubMedGoogle Scholar
  234. 236.
    DiSaia PJ, Castro JR, Rutledge FN. Mixed mesodermal sarcoma of the uterus. Am J Roentgenol Radium Ther Nucl Med 1973;117:632–636.PubMedGoogle Scholar
  235. 237.
    Dinh TV, Slavin RE, Bhagavan BS, Hannigan EV, Tiamson EM, Yandell RB. Mixed mullerian tumors of the uterus: a clinicopathologic study. Obstet Gynecol 1989;74:388–392.PubMedGoogle Scholar
  236. 238.
    Silverberg SG, Major FJ, Blessing JA, et al. Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus. A Gynecologic Oncology Group pathologic study of 203 cases. Int J Gynecol Pathol 1990;9:1–19.PubMedGoogle Scholar
  237. 239.
    Vaidya AP, Horowitz NS, Oliva E, Halpern EF, Duska LR. Uterine malignant mixed mullerian tumors should not be included in studies of endometrial carcinoma. Gynecol Oncol 2006;103:684–687.PubMedGoogle Scholar
  238. 240.
    Amant F, Cadron I, Fuso L, et al. Endometrial carcinosarcomas have a different prognosis and pattern of spread compared to high-risk epithelial endometrial cancer. Gynecol Oncol 2005;98:274–280.PubMedGoogle Scholar
  239. 241.
    Iwasa Y, Haga H, Konishi I, et al. Prognostic factors in uterine carcinosarcoma: a clinicopathologic study of 25 patients. Cancer 1998;82:512–519.PubMedGoogle Scholar
  240. 242.
    Sartori E, Bazzurini L, Gadducci A, et al. Carcinosarcoma of the uterus: a clinicopathological multicenter CTF study. Gynecol Oncol 1997;67:70–75.PubMedGoogle Scholar
  241. 243.
    Inthasorn P, Carter J, Valmadre S, Beale P, Russell P, Dalrymple C. Analysis of clinicopathologic factors in malignant mixed Mullerian tumors of the uterine corpus. Int J Gynecol Cancer 2002;12:348–353.PubMedGoogle Scholar
  242. 244.
    Larson B, Silfversward C, Nilsson B, Pettersson F. Mixed mullerian tumours of the uterus – prognostic factors: a clinical and histopathologic study of 147 cases. Radiother Oncol 1990;17:123–132.PubMedGoogle Scholar
  243. 245.
    Nola M, Babic D, Ilic J, et al. Prognostic parameters for survival of patients with malignant mesenchymal tumors of the uterus. Cancer 1996;78:2543–2550.PubMedGoogle Scholar
  244. 246.
    Yamada SD, Burger RA, Brewster WR, Anton D, Kohler MF, Monk BJ. Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus. Cancer 2000;88:2782–2786.PubMedGoogle Scholar
  245. 247.
    Arrastia CD, Fruchter RG, Clark M, et al. Uterine carcinosarcomas: incidence and trends in management and survival. Gynecol Oncol 1997;65:158–163.PubMedGoogle Scholar
  246. 248.
    Gerszten K, Faul C, Kounelis S, Huang Q, Kelley J, Jones MW. The impact of adjuvant radiotherapy on carcinosarcoma of the uterus. Gynecol Oncol 1998;68:8–13.PubMedGoogle Scholar
  247. 249.
    Nordal RR, Kristensen GB, Stenwig AE, Nesland JM, Pettersen EO, Trope CG. An evaluation of prognostic factors in uterine carcinosarcoma. Gynecol Oncol 1997;67:316–321.PubMedGoogle Scholar
  248. 250.
    Barwick KW, LiVolsi VA. Malignant mixed mullerian tumors of the uterus. A clinicopathologic assessment of 34 cases. Am J Surg Pathol 1979;3:125–135.PubMedGoogle Scholar
  249. 251.
    Kanbour AI, Buchsbaum HJ, Hall A. Peritoneal cytology in malignant mixed mullerian tumors of the uterus. Gynecol Oncol 1989;33:91–95.PubMedGoogle Scholar
  250. 252.
    Lotocki R, Rosenshein NB, Grumbine F, Dillon M, Parmley T, Woodruff JD. Mixed Mullerian tumors of the uterus: clinical and pathologic correlations. Int J Gynaecol Obstet 1982;20:237–243.PubMedGoogle Scholar
  251. 253.
    Blom R, Guerrieri C, Stal O, Malmstrom H, Sullivan S, Simonsen E. Malignant mixed Mullerian tumors of the uterus: a clinicopathologic, DNA flow cytometric, p53, and mdm-2 analysis of 44 cases. Gynecol Oncol 1998;68:18–24.PubMedGoogle Scholar
  252. 254.
    Jazaeri AA, Nunes KJ, Dalton MS, Xu M, Shupnik MA, Rice LW. Well-differentiated endometrial adenocarcinomas and poorly differentiated mixed mullerian tumors have altered ER and PR isoform expression. Oncogene 2001;20:6965–6969.PubMedGoogle Scholar
  253. 255.
    Norris HJ, Taylor HB. Mesenchymal tumors of the uterus. I. A clinical and pathological study of 53 endometrial stromal tumors. Cancer 1966;19:755–766.PubMedGoogle Scholar
  254. 256.
    Larson B, Silfversward C, Nilsson B, Pettersson F. Endometrial stromal sarcoma of the uterus. A clinical and histopathological study. The Radiumhemmet series 1936–1981. Eur J Obstet Gynecol Reprod Biol 1990;35:239–249.PubMedGoogle Scholar
  255. 257.
    Chang KL, Crabtree GS, Lim-Tan SK, Kempson RL, Hendrickson MR. Primary uterine endometrial stromal neoplasms. A clinicopathologic study of 117 cases. Am J Surg Pathol 1990;14:415–438.PubMedGoogle Scholar
  256. 258.
    De Fusco PA, Gaffey TA, Malkasian GD, Jr., Long HJ, Cha SS. Endometrial stromal sarcoma: review of Mayo Clinic experience, 1945–1980. Gynecol Oncol 1989;35:8–14.PubMedGoogle Scholar
  257. 259.
    August CZ, Bauer KD, Lurain J, Murad T. Neoplasms of endometrial stroma: histopathologic and flow cytometric analysis with clinical correlation. Hum Pathol 1989;20:232–237.PubMedGoogle Scholar
  258. 260.
    El-Naggar AK, Abdul-Karim FW, Silva EG, McLemore D, Garnsey L. Uterine stromal neoplasms: a clinicopathologic and DNA flow cytometric correlation. Hum Pathol 1991;22:897–903.PubMedGoogle Scholar
  259. 261.
    Spano JP, Soria JC, Kambouchner M, et al. Long-term survival of patients given hormonal therapy for metastatic endometrial stromal sarcoma. Med Oncol 2003;20:87–93.PubMedGoogle Scholar
  260. 262.
    Maluf FC, Sabbatini P, Schwartz L, Xia J, Aghajanian C. Endometrial stromal sarcoma: objective response to letrozole. Gynecol Oncol 2001;82:384–388.PubMedGoogle Scholar
  261. 263.
    Leunen M, Breugelmans M, De Sutter P, Bourgain C, Amy JJ. Low-grade endometrial stromal sarcoma treated with the aromatase inhibitor letrozole. Gynecol Oncol 2004;95:769–771.PubMedGoogle Scholar
  262. 264.
    Balleine RL, Earls PJ, Webster LR, et al. Expression of progesterone receptor A and B isoforms in low-grade endometrial stromal sarcoma. Int J Gynecol Pathol 2004;23:138–144.PubMedGoogle Scholar
  263. 265.
    Gadducci A, Sartori E, Landoni F, et al. Endometrial stromal sarcoma: analysis of treatment failures and survival. Gynecol Oncol 1996;63:247–253.PubMedGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of PathologyMassachusetts General HospitalBoston

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