Ian S Hagemann1, Wei Deng2, Richard J Zaino3, Matthew A Powell4, Camille Gunderson5, Casey Cosgrove6, Cara Mathews7, Michael L Pearl8, Steven Waggoner9, Rahel Ghebre10, Shashikant Lele11, Saketh Guntupalli12, Angeles Alvarez Secord13, Olga Ioffe14, Kay Park15, Golnar Rasty16, Meenakshi Singh17, Robert Soslow18, William Creasman19, David G Mutch20. 1. Washington University School of Medicine, St. Louis, MO, USA. Electronic address: hagemani@wustl.edu. 2. NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics: Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. Electronic address: dengw@nrgoncology.org. 3. Pennsylvania State University, Hershey, PA, USA. Electronic address: rzaino@psu.edu. 4. Washington University School of Medicine, St. Louis, MO, USA. Electronic address: mpowell@wustl.edu. 5. University of Oklahoma Health Sciences Center and Stephenson Cancer Center, Oklahoma City, OK, USA. Electronic address: Camille-Gunderson@ouhsc.edu. 6. Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. Electronic address: Casey.Cosgrove@osumc.edu. 7. Women & Infants Hospital, Providence, RI, USA. Electronic address: CMathews@Wihri.org. 8. Stony Brook University Medical Center, Stony Brook, NY, USA. Electronic address: Michael.pearl@sbumed.org. 9. Case Western Reserve University, Cleveland, OH, USA. Electronic address: steven.waggoner@uhhospitals.org. 10. University of Minnesota Medical School, Minneapolis, MN, USA. Electronic address: ghebr004@umn.edu. 11. Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. Electronic address: Shashi.lele@roswellpark.org. 12. University of Colorado Cancer Center, Aurora, CO, USA. Electronic address: saketh.guntupalli@ucdenver.edu. 13. Duke University Medical Center, Durham, NC, USA. Electronic address: Secord@duke.edu. 14. University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: oioffe@fpi.umaryland.edu. 15. Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: parkk@mskcc.org. 16. University of Toronto, Markham, ONT, USA. Electronic address: grasty@msh.on.ca. 17. Stony Brook University Medical Center, Stony Brook, NY, USA. 18. Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: soslowr@mskcc.org. 19. Medical University of South Carolina Medical Center, Charleston, SC, USA. Electronic address: creasman@musc.edu. 20. Washington University School of Medicine, St. Louis, MO, USA. Electronic address: mutchd@wustl.edu.
Abstract
OBJECTIVE: While most cases of endometrial cancer can readily be classified as pure endometrioid, pure serous, or another type, others show an apparent mixture of serous and endometrioid components, or indeterminate serous versus endometrioid features. Since serous histology carries a worse prognosis than endometrioid, Gynecologic Oncology Group protocol GOG-8032 was established to examine whether the presence of a non-serous component is a favorable feature in an otherwise serous cancer. METHODS: 934 women with serous cancer were prospectively identified among a larger group enrolled in GOG-0210. Six expert gynecologic pathologists classified each case as pure serous (SER, n=663), mixed serous and endometrioid (SER-EM-M, n=138), or indeterminate serous v. endometrioid (SER-EM-I, n=133) by H&E morphology. Follow-up data from GOG-0210 were analyzed. RESULTS: The subgroups did not differ on BMI, race, ethnicity, lymphovascular invasion, cervical invasion, ovary involvement, peritoneal involvement, omental involvement, FIGO stage, or planned adjuvant treatment. SER-EM-M patients were younger (p=0.0001) and less likely to have nodal involvement (p=0.0287). SER patients were less likely to have myoinvasion (p=0.0002), and more likely to have adnexal involvement (p=0.0108). On univariate analysis, age, serous subtype, race, and components of FIGO staging predicted both progression-free and overall survival. On multiple regression, however, serous subtype (SER, SER-EM-M, or SER-EM-I) did not significantly predict survival. CONCLUSIONS: There were few clinicopathologic differences between cases classified as SER, SER-EM-M, and SER-EM-I. Cases with a mixture of serous and endometrioid morphology, as well as cases with morphology indeterminate for serous v. endometrioid type, had the same survival as pure serous cases. NCT#: NCT00340808.
OBJECTIVE: While most cases of endometrial cancer can readily be classified as pure endometrioid, pure serous, or another type, others show an apparent mixture of serous and endometrioid components, or indeterminate serous versus endometrioid features. Since serous histology carries a worse prognosis than endometrioid, Gynecologic Oncology Group protocol GOG-8032 was established to examine whether the presence of a non-serous component is a favorable feature in an otherwise serous cancer. METHODS: 934 women with serous cancer were prospectively identified among a larger group enrolled in GOG-0210. Six expert gynecologic pathologists classified each case as pure serous (SER, n=663), mixed serous and endometrioid (SER-EM-M, n=138), or indeterminate serous v. endometrioid (SER-EM-I, n=133) by H&E morphology. Follow-up data from GOG-0210 were analyzed. RESULTS: The subgroups did not differ on BMI, race, ethnicity, lymphovascular invasion, cervical invasion, ovary involvement, peritoneal involvement, omental involvement, FIGO stage, or planned adjuvant treatment. SER-EM-M patients were younger (p=0.0001) and less likely to have nodal involvement (p=0.0287). SER patients were less likely to have myoinvasion (p=0.0002), and more likely to have adnexal involvement (p=0.0108). On univariate analysis, age, serous subtype, race, and components of FIGO staging predicted both progression-free and overall survival. On multiple regression, however, serous subtype (SER, SER-EM-M, or SER-EM-I) did not significantly predict survival. CONCLUSIONS: There were few clinicopathologic differences between cases classified as SER, SER-EM-M, and SER-EM-I. Cases with a mixture of serous and endometrioid morphology, as well as cases with morphology indeterminate for serous v. endometrioid type, had the same survival as pure serous cases. NCT#: NCT00340808.
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