Risk factor analysis of recurrence in low-grade endometrial adenocarcinoma

Andres A. Roma, Lisa A. Rybicki, Denise Barbuto, Elizabeth Euscher, Bojana Djordjevic, Elizabeth Frauenhoffer, Insun Kim, Sung Ran Hong, Delia Montiel, Rouba Ali-Fehmi, Anais Malpica, Elvio G. Silva

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Summary Prognosis of endometrial adenocarcinoma is favorable; however, the risk of recurrence ranges from 7% to 13%. Recurrence has been related to age, tumor type, International Federation of Gynecology and Obstetrics grade, depth of invasion, and lymphovascular invasion (LVI); however, morphologic features that would predict the site of recurrence have not been established. In this multi-institutional study, we reviewed 589 patients with International Federation of Gynecology and Obstetrics grades 1 or 2 endometrial adenocarcinoma, endometrioid type. Cox proportional hazard analysis was used to identify univariate and multivariate risk factors for recurrence and survival. Univariate analysis revealed features of tumors that recurred only in the vagina: low nuclear grade; superficial myoinvasion; minimal to no LVI; and minimal myoinvasion with microcystic, elongated, and fragmented (MELF) pattern; low nuclear grade and superficial myoinvasion persisted on multivariate analysis. Features of tumors that recurred at other sites included large size, deep myoinvasion, tumor necrosis, 1 or more LVI foci, LVI foci distant/deeper than invasive tumor front, MELF myoinvasion pattern, lower uterine segment and cervical stromal involvement, pelvic and/or paraaortic lymph node metastases at presentation, and higher grade of tumor in the metastatic foci, whereas increased percentage of solid component and lower percentage of mucinous features were marginally associated. Tumors with recurrences only in vagina had different features than tumors that recurred at other sites. The presence of tumor necrosis, MELF foci at the invasive tumor front, and the percentage of solid component and mucinous features could be helpful in grading endometrioid adenocarcinomas, if a 2-tier rather than a 3-tier grading system is accepted in the future.

Original languageEnglish (US)
Pages (from-to)1529-1539
Number of pages11
JournalHuman Pathology
Volume46
Issue number10
DOIs
StatePublished - Oct 1 2015

Fingerprint

Statistical Factor Analysis
Adenocarcinoma
Recurrence
Neoplasms
Endometrioid Carcinoma
Vagina
Gynecology
Obstetrics
Necrosis
Multivariate Analysis
Lymph Nodes
Neoplasm Metastasis
Survival

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine

Cite this

Roma, A. A., Rybicki, L. A., Barbuto, D., Euscher, E., Djordjevic, B., Frauenhoffer, E., ... Silva, E. G. (2015). Risk factor analysis of recurrence in low-grade endometrial adenocarcinoma. Human Pathology, 46(10), 1529-1539. https://doi.org/10.1016/j.humpath.2015.06.015
Roma, Andres A. ; Rybicki, Lisa A. ; Barbuto, Denise ; Euscher, Elizabeth ; Djordjevic, Bojana ; Frauenhoffer, Elizabeth ; Kim, Insun ; Hong, Sung Ran ; Montiel, Delia ; Ali-Fehmi, Rouba ; Malpica, Anais ; Silva, Elvio G. / Risk factor analysis of recurrence in low-grade endometrial adenocarcinoma. In: Human Pathology. 2015 ; Vol. 46, No. 10. pp. 1529-1539.
@article{5c1eaf3150f0423cbb284d068bb9b744,
title = "Risk factor analysis of recurrence in low-grade endometrial adenocarcinoma",
abstract = "Summary Prognosis of endometrial adenocarcinoma is favorable; however, the risk of recurrence ranges from 7{\%} to 13{\%}. Recurrence has been related to age, tumor type, International Federation of Gynecology and Obstetrics grade, depth of invasion, and lymphovascular invasion (LVI); however, morphologic features that would predict the site of recurrence have not been established. In this multi-institutional study, we reviewed 589 patients with International Federation of Gynecology and Obstetrics grades 1 or 2 endometrial adenocarcinoma, endometrioid type. Cox proportional hazard analysis was used to identify univariate and multivariate risk factors for recurrence and survival. Univariate analysis revealed features of tumors that recurred only in the vagina: low nuclear grade; superficial myoinvasion; minimal to no LVI; and minimal myoinvasion with microcystic, elongated, and fragmented (MELF) pattern; low nuclear grade and superficial myoinvasion persisted on multivariate analysis. Features of tumors that recurred at other sites included large size, deep myoinvasion, tumor necrosis, 1 or more LVI foci, LVI foci distant/deeper than invasive tumor front, MELF myoinvasion pattern, lower uterine segment and cervical stromal involvement, pelvic and/or paraaortic lymph node metastases at presentation, and higher grade of tumor in the metastatic foci, whereas increased percentage of solid component and lower percentage of mucinous features were marginally associated. Tumors with recurrences only in vagina had different features than tumors that recurred at other sites. The presence of tumor necrosis, MELF foci at the invasive tumor front, and the percentage of solid component and mucinous features could be helpful in grading endometrioid adenocarcinomas, if a 2-tier rather than a 3-tier grading system is accepted in the future.",
author = "Roma, {Andres A.} and Rybicki, {Lisa A.} and Denise Barbuto and Elizabeth Euscher and Bojana Djordjevic and Elizabeth Frauenhoffer and Insun Kim and Hong, {Sung Ran} and Delia Montiel and Rouba Ali-Fehmi and Anais Malpica and Silva, {Elvio G.}",
year = "2015",
month = "10",
day = "1",
doi = "10.1016/j.humpath.2015.06.015",
language = "English (US)",
volume = "46",
pages = "1529--1539",
journal = "Human Pathology",
issn = "0046-8177",
publisher = "W.B. Saunders Ltd",
number = "10",

}

Roma, AA, Rybicki, LA, Barbuto, D, Euscher, E, Djordjevic, B, Frauenhoffer, E, Kim, I, Hong, SR, Montiel, D, Ali-Fehmi, R, Malpica, A & Silva, EG 2015, 'Risk factor analysis of recurrence in low-grade endometrial adenocarcinoma', Human Pathology, vol. 46, no. 10, pp. 1529-1539. https://doi.org/10.1016/j.humpath.2015.06.015

Risk factor analysis of recurrence in low-grade endometrial adenocarcinoma. / Roma, Andres A.; Rybicki, Lisa A.; Barbuto, Denise; Euscher, Elizabeth; Djordjevic, Bojana; Frauenhoffer, Elizabeth; Kim, Insun; Hong, Sung Ran; Montiel, Delia; Ali-Fehmi, Rouba; Malpica, Anais; Silva, Elvio G.

In: Human Pathology, Vol. 46, No. 10, 01.10.2015, p. 1529-1539.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk factor analysis of recurrence in low-grade endometrial adenocarcinoma

AU - Roma, Andres A.

AU - Rybicki, Lisa A.

AU - Barbuto, Denise

AU - Euscher, Elizabeth

AU - Djordjevic, Bojana

AU - Frauenhoffer, Elizabeth

AU - Kim, Insun

AU - Hong, Sung Ran

AU - Montiel, Delia

AU - Ali-Fehmi, Rouba

AU - Malpica, Anais

AU - Silva, Elvio G.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Summary Prognosis of endometrial adenocarcinoma is favorable; however, the risk of recurrence ranges from 7% to 13%. Recurrence has been related to age, tumor type, International Federation of Gynecology and Obstetrics grade, depth of invasion, and lymphovascular invasion (LVI); however, morphologic features that would predict the site of recurrence have not been established. In this multi-institutional study, we reviewed 589 patients with International Federation of Gynecology and Obstetrics grades 1 or 2 endometrial adenocarcinoma, endometrioid type. Cox proportional hazard analysis was used to identify univariate and multivariate risk factors for recurrence and survival. Univariate analysis revealed features of tumors that recurred only in the vagina: low nuclear grade; superficial myoinvasion; minimal to no LVI; and minimal myoinvasion with microcystic, elongated, and fragmented (MELF) pattern; low nuclear grade and superficial myoinvasion persisted on multivariate analysis. Features of tumors that recurred at other sites included large size, deep myoinvasion, tumor necrosis, 1 or more LVI foci, LVI foci distant/deeper than invasive tumor front, MELF myoinvasion pattern, lower uterine segment and cervical stromal involvement, pelvic and/or paraaortic lymph node metastases at presentation, and higher grade of tumor in the metastatic foci, whereas increased percentage of solid component and lower percentage of mucinous features were marginally associated. Tumors with recurrences only in vagina had different features than tumors that recurred at other sites. The presence of tumor necrosis, MELF foci at the invasive tumor front, and the percentage of solid component and mucinous features could be helpful in grading endometrioid adenocarcinomas, if a 2-tier rather than a 3-tier grading system is accepted in the future.

AB - Summary Prognosis of endometrial adenocarcinoma is favorable; however, the risk of recurrence ranges from 7% to 13%. Recurrence has been related to age, tumor type, International Federation of Gynecology and Obstetrics grade, depth of invasion, and lymphovascular invasion (LVI); however, morphologic features that would predict the site of recurrence have not been established. In this multi-institutional study, we reviewed 589 patients with International Federation of Gynecology and Obstetrics grades 1 or 2 endometrial adenocarcinoma, endometrioid type. Cox proportional hazard analysis was used to identify univariate and multivariate risk factors for recurrence and survival. Univariate analysis revealed features of tumors that recurred only in the vagina: low nuclear grade; superficial myoinvasion; minimal to no LVI; and minimal myoinvasion with microcystic, elongated, and fragmented (MELF) pattern; low nuclear grade and superficial myoinvasion persisted on multivariate analysis. Features of tumors that recurred at other sites included large size, deep myoinvasion, tumor necrosis, 1 or more LVI foci, LVI foci distant/deeper than invasive tumor front, MELF myoinvasion pattern, lower uterine segment and cervical stromal involvement, pelvic and/or paraaortic lymph node metastases at presentation, and higher grade of tumor in the metastatic foci, whereas increased percentage of solid component and lower percentage of mucinous features were marginally associated. Tumors with recurrences only in vagina had different features than tumors that recurred at other sites. The presence of tumor necrosis, MELF foci at the invasive tumor front, and the percentage of solid component and mucinous features could be helpful in grading endometrioid adenocarcinomas, if a 2-tier rather than a 3-tier grading system is accepted in the future.

UR - http://www.scopus.com/inward/record.url?scp=84941934470&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84941934470&partnerID=8YFLogxK

U2 - 10.1016/j.humpath.2015.06.015

DO - 10.1016/j.humpath.2015.06.015

M3 - Article

C2 - 26264257

AN - SCOPUS:84941934470

VL - 46

SP - 1529

EP - 1539

JO - Human Pathology

JF - Human Pathology

SN - 0046-8177

IS - 10

ER -