Uterine Cancer pp 145-154 | Cite as

Prognostic and Predictive Factors in the Management of Carcinoma Endometrium

  • K. Chitrathara


Carcinoma Endometrium is the most common gynecological malignancy in the west. It ranks third in India after cervix and ovary. Women with endometrial cancer are usually diagnosed at an early stage, as most present with irregular bleeding or abnormal vaginal discharge and surgery is curative. A few subset of women may present with high risk histological factors or are in an advanced stage of disease. These women will need multimodality treatment to achieve a cure. The overall 5-year survival is 80–90 % in stage 1 tumors. With the advent of molecular and genetic factors, preoperative predictors of poor prognosis are needed to select women for adjuvant treatment to improve the disease free survival.


Endometrial Cancer Endometrial Carcinoma Myometrial Invasion Endometrial Cancer Patient Endometrioid Adenocarcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Morrow CP, Bundy BN, Kurman RJ, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage 1 and 11 carcinoma of the endometrium. A gynecologic oncology group study. Gynecol Oncol. 1991;40:55.PubMedCrossRefGoogle Scholar
  2. 2.
    Christopherson WM, Connelly PJ, Alberhasky RC. Carcinoma of the endometrium. An analysis of prognosticators in patients with favourable subtypes and stage 1 disease. Cancer. 1983;51:1705.PubMedCrossRefGoogle Scholar
  3. 3.
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Uterine Neoplasm. 2014; Version 1.Google Scholar
  4. 4.
    Hendrickson M, Ross J, Eifel PJ, et al. Adenocarcinoma of the endometrium: analysis of 256 cases with carcinoma limited to the uterine carpus. Pathol review and analysis of prognostic variables. Gynecol Oncol. 1982;13(3):373–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Nori D, Hilaris BS, Tame M, et al. Combined surgery and radiation in endometrial carcinoma; an analysis prognostic factors. Int J Radiat Oncol Biol Phys. 1987;13(4):489–97.PubMedCrossRefGoogle Scholar
  6. 6.
    De Góis NM, Martins NV, Abrão FS. Peritumorous lymph-vascular invasion, grade of histologic differentiation, and myometrial infiltration as prognostic factors of endometrial carcinoma. Rev Paul Med. 1993;111(3):385–90.PubMedGoogle Scholar
  7. 7.
    Trimble EWL, Jones HW. Management of stage 11 endometrial carcinoma. Obstet Gynecol. 1988;71:323–6.PubMedGoogle Scholar
  8. 8.
    Doll KM, Denslow S, Tseng J, et al. Clinical study predictive and prognostic factors in definition of risk groups in endometrial carcinoma. J Clin Oncol. 2013;31 Suppl; abstr 5589.Google Scholar
  9. 9.
    Mariani A, Webb MJ, Keeney GL, et al. Surgical stage I endometrial cancer: predictors of distant failure and death. Gynecol Oncol. 2002;87:274–80.PubMedCrossRefGoogle Scholar
  10. 10.
    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;99:564–70.PubMedCrossRefGoogle Scholar
  11. 11.
    Chitrathara K, Khan A, Neetha S, et al. Discrepancy between clinicoradiological and surgicopathological staging in stage 1 carcinoma endometrium: identification of risk factors. Indian J Cancer 2014; (accepted for publication in 2014).Google Scholar
  12. 12.
    Creaseman WT, Morrow CP, Bundy L, et al. Surgical pathological spread patterns of endometrial cancer. Cancer. 1987;60:2035.CrossRefGoogle Scholar
  13. 13.
    Turner DA, Gershenson DM, Atkinson N, Sneige N, Wharton AT. The prognostic significance of peritoneal cytology for stage I endometrial cancer. Obstet Gynecol. 1989;74:775–80.PubMedGoogle Scholar
  14. 14.
    Kadar N, Homesly HD, Malfenato JH. Positive peritoneal cytology is an adverse factor in endometrial carcinoma only if there is other evidence of extrauterine disease. Gynecol Oncol. 1992;46(2):145–9.PubMedCrossRefGoogle Scholar
  15. 15.
    McLellan R, Dillon MB, Currie JL, Rosenshein NB. Peritoneal cytology in endometrial cancer: a review. Obstet Gynecol Surv. 1989;44:711–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Lurain JR. The significance of positive peritoneal cytology in endometrial cancer. Gynecol Oncol. 1992;46:143–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Hirai Y, Takeshima N, Kato T, Hasumi K. Malignant potential of positive peritoneal cytology in endometrial cancer. Obstet Gynecol. 2001;97:725–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Kasamatsu T, Onda T, Katsumata N. Prognostic significance of positive peritoneal cytology in endometrial carcinoma confined to the uterus. Br J Cancer. 2003;88(2):147–50.PubMedCentralCrossRefGoogle Scholar
  19. 19.
    Mundt AJ, Waggoner S, Yamada D. Age as a prognostic factor for recurrence in patients with endometrial carcinoma. Gynecol Oncol. 2000;79:79–85.PubMedCrossRefGoogle Scholar
  20. 20.
    Fleming ND, Lentz SE, Cass I. Is older age a poor prognostic factor in stage I and II endometrioid endometrial adenocarcinoma? Gynecol Oncol. 2011;120(2):189–92.PubMedCrossRefGoogle Scholar
  21. 21.
    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(1):31–46.PubMedCrossRefGoogle Scholar
  22. 22.
    Hicks ML, Kim W, Abrams J, Johnson CC. Racial differences in surgically staged patients with endometrial cancer. J Natl Med Assoc. 1997;89(2):134–40.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Allard JE, Maxwell GL. Race disparities between black and white women in the incidence, treatment, and prognosis of endometrial cancer. Cancer Control. 2009;16(1):53–6.PubMedGoogle Scholar
  24. 24.
    Sorbe B. Clinical study; Predictive and prognostic factors in definition of risk groups in endometrial carcinoma. ISRN Obstet Gynecol. 2012:Article ID 325790.Google Scholar
  25. 25.
    Gadducci A, Cavazzana A, Cosio S, et al. Lymph-vascular space involvement and outer one-third myometrial invasion are strong predictors of distant haematogeneous failures in patients with stage I–II endometrioid-type endometrial cancer. Anticancer Res. 2009;29(5):1715–20.PubMedGoogle Scholar
  26. 26.
    Narayan K, Khaw P, Bernshaw D, et al. Prognostic significance of lymphovascular space invasion and nodal involvement in intermediate- and high-risk endometrial cancer patients treated with curative intent using surgery and adjuvant radiotherapy. Int J Gynecol Cancer. 2012;22(2):260–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Loizzi V, Cormio G, Lorusso M, et al. The impact of lymph vascular space invasion on recurrence and survival in patients with early stage endometrial cancer. Eur J Cancer Care (Engl). 2014;23(3):380–4. doi: 10.1111/ecc.12115. Epub 23 Sept 2013.CrossRefGoogle Scholar
  28. 28.
    Hongberg T, Signorelli C, de Olivera CF, et al. Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer-results of two randomized studies. Eur J Cancer. 2010;36(2):371–8.Google Scholar
  29. 29.
    Sorbe B, Nordestrom J, Maepaa J, et al. Intravaginal brachytherapy in FIGO stage1 low risk endometrial cancer; a controlled randomized study. Int J Gynecol Cancer. 2009;19(5):873–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Sorbe B, Horvath G, Anderson H, et al. External pelvic and vaginal irradiation versus vaginal irradiation alone as postoperative therapy in medium risk endometrial carcinoma- a prospective randomized study. Int J Radiat Oncol Biol Phys. 2012;82(3):1249–55.PubMedCrossRefGoogle Scholar
  31. 31.
    Espino-strebel EE, Luna JTP. Correlation between pre-operative serum CA 125 and surgicopathologic prognostic factors. Gynecol Obstet. ISSN: 2161-0932.Google Scholar
  32. 32.
    Denschlag D, Tan L, Patel S, et al. Stage III endometrial cancer: preoperative predictability, prognostic factors, and treatment outcome. Am J Obstet Gynecol. 2007;196(6):546e1–7.CrossRefGoogle Scholar
  33. 33.
    Lo SS, Cheng DK, Ng TY, et al. Prognostic significance of tumour markers in endometrial cancer. JCT. 2013:966–970.Google Scholar
  34. 34.
    Hetzel DJ, Wilson TO, Keeney GL, et al. HER-2/neu expression: a major prognostic factor in endometrial cancer. Gynecol Oncol. 1992;47(2):179–85.PubMedCrossRefGoogle Scholar
  35. 35.
    Gurpride E. Endometrial cancer: biochemical and clinical correlates. J Natl Cancer Inst. 1991;83(6):406–16.Google Scholar
  36. 36.
    Salvesen HB, Iversen OE, Akslen LA. A population-based endometrial carcinoma study – prognostic significance of angiogenesis and Ki-67, p53, and p21 expression. J Clin Oncol. 1999;17(5):1382–90.PubMedGoogle Scholar
  37. 37.
    Creasman WT. Prognostic significance of hormone receptors in endometrial cancer. Cancer. 1993;71(4 Suppl):1467–70.PubMedCrossRefGoogle Scholar
  38. 38.
    Carcangiu ML, Chambers JT, Voynick IM, et al. Immunohistochemical evaluation of oestrogen and progesterone receptor content in 183 patients with endometrial carcinoma. Part 1: clinical and histological correlation. Am J Clin Pathol. 1990;94(3):247–54.PubMedGoogle Scholar
  39. 39.
    Chambers JT, Carcangiu ML, Voynick IM, et al. Immunohistochemical evaluation of oestrogen and progesterone receptor content in 183 patients with endometrial carcinoma. Part 11: correlation between biochemical and immunohistochemical methods and survival. Am J Clin Pathol. 1990;94(3):255–60.PubMedGoogle Scholar
  40. 40.
    Ingram SS, Rosenman J, Heath R, et al. The predictive value of progesterone receptor levels in endometrial cancer. Int J Radiat Oncol Biol Phys. 1989;17(1):21–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Huvila J, Talve L, Carpén O, et al. A progesterone receptor negativity is an independent risk factor for relapse in patients with early stage endometrioid endometrial adenocarcinoma. Gynecol Oncol. 2013;130(3):463–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Yao YY, Xu WZ, Wang Y, et al. Relationships between the molecular biomarkers and the clinicopathologic features and prognosis in endometrial carcinoma. Beijing Da Xue Xue Bao. 2011;43(5):743–8. English abstract.PubMedGoogle Scholar
  43. 43.
    Susini T, Baldi F, Howard CM, et al. Expression of the retinoblastoma-related gene Rb2/p130 correlates with clinical outcome in endometrial cancer. J Clin Oncol. 1998;16:1085–93.PubMedGoogle Scholar
  44. 44.
    Susini T, Massi D, Paglierani M, et al. Expression of the retinoblastoma-related gene Rb2/p130 is downregulated in atypical endometrial hyperplasia and adenocarcinoma. Hum Pathol. 2001;32(4):360–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Mhawech-Fauceglia P, Wang D, Kim G, et al. Expression of DNA repair proteins in endometrial cancer predicts disease outcome. Gynecol Oncol. 2014;132(3):593–8. doi: 10.1016/j.ygyno.2014.02.002. Epub 6 Feb 2014.PubMedCrossRefGoogle Scholar
  46. 46.
    Gao QL, Ye F, Li J, et al. PTEN coding product: a marker for tumorigenesis and progression of endometrial carcinoma. Ai Zheng. 2003;22(6):640–4.PubMedGoogle Scholar
  47. 47.
    Pallares J, Bussaglia E, Martínez-Guitarte JL, et al. Immunohistochemical analysis of PTEN in endometrial carcinoma: a tissue microarray study with a comparison of four commercial antibodies in correlation with molecular abnormalities. Mod Pathol. 2005;18(5):719–27.PubMedCrossRefGoogle Scholar
  48. 48.
    Konstantinos K, Marios S, Anna M, et al. Expression of p53 in imprint smears of endometrial carcinoma. Diagn Cytopathol. 2014;42(5):416–22. doi: 10.1002/dc.23056. Epub 25 Oct 2013.PubMedCrossRefGoogle Scholar
  49. 49.
    Inaba F, Yamazaki T, Fukasawa I, et al. Endometrial adenosquamous carcinoma with osteoclast-like giant cells: immunohistochemistry and histogenesis. Oncol Rep. 2005;13(1):17–24.PubMedGoogle Scholar
  50. 50.
    Karaayvaz M, Zhang C, Liang S. Prognostic significance of miR-205 in endometrial cancer. 2012. doi: 10.1371/journal.pone.0035158
  51. 51.
    Ugaki H, Yoshino K, Fujita M, et al. Endometrial carcinoma with extra-abdominal metastasis: improved prognosis following cytoreductive surgery. Ann Surg Oncol. 2010;17(4):1111–7. doi: 10.1245/s10434-009-0892-8.PubMedCrossRefGoogle Scholar
  52. 52.
    Ghassan A, Bernardini MQ, Ren-Chin Wu RC, et al. ARID1A loss correlates with mismatch repair deficiency and intact p53 expression in high-grade endometrial carcinomas. Mod Pathol. 2014;27:255–61. doi: 10.1038/modpathol.2013.144.CrossRefGoogle Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  1. 1.Department of Surgical and Gynecologic OncologyWelcare HospitalKochiIndia
  2. 2.Lakeshore Hospital and Research CentreKochiIndia

Personalised recommendations