Clinicopathological study of endometrial cancer -A review of 120 cases-

Abstract

Although the incidence of endometrial carcinoma of the uterus (cancer of corpus uteri) has been increasing in recent years, the etiology of this disease has yet to be fully elucidated, unlike that of cervical carcinoma, and especially that of squamous cell carcinoma. Therefore, we performed clinicopathological studies of endometrial carcinoma, evaluated the therapeutic outcome, and discussed problems in the treatment of 120 patients with endometrial carcinoma who were treated at the OB-GYN Department, Kansai Medical College during the past eleven years (1983to 1993).
1. The incidence of endometrial carcinoma has been increasing in this department; it comprised 14.1% of all cases of uterine carcinoma in 1983, and 27.7% of all such cases in 1993.
2. The mean age of patients with endometrial carcinoma was 57.0 yeas; that of patients which clinical stage I was 47.7 years, while that of patients with disease of clinical stage II or higher was between 56.7 and 58.0 years. Thus, patients with disease of clinical stage II or higher were a mean of 10 years older than those with clinical stage I disease. Three patients were less than 30 years of age. Endometrial carcinoma was seen more frequently among who had few pregnancies, and 78 (65.0%) of the patients were postmenopausal.
3. The chief complaint was genital bleeding in most cases (94 cases (78.3%) of all cases).
4. Endometrial cytology was performed for preoperative diagnosis, and the rate of coorect diagnosis was 69.2%. Tumor markers were also studied in 91 cases,42.9% of the patients were positive for CAl25, while 47.3% were positive for CA19-9. In addition, endometrial carcinoma was discovered postoperatively (e. g. following surgery for uterine myoma) in nine patients.
5. As a rule, the patients in this study underwent hysterectomy, and radical resection of uterine carcinoma or simple total resection was performed in accordance with the extent of tumor infiltration. Since 1986, chemotherapeutic agents (primarily cisplatin (CDDP) were adminis tered concomitantly during surgery or postoperatively, and maintenace therapy was performed with 5-FU.
6. The five-year survival rates for the 59 patients were as follows (up to 1988); patients: with stage I disease: 84%, with stage II disease: 83%, with stage III: 75%, and with stage IV\disease: 40%. The percentages of patients surviving at present are as follows: stage I: 87.8%stage II: 91.7%, stage III: 80.0%, and stage IV: 30.8%. Recurrence of disease and mortality was: observed in 21 cases (17.5%). The sites of recurrence in the 21 patients who died were as fol lows; local (intrapelvic): 10 cases (25.0%), peritonitis carcinoma-tosis: 9 cases (22.5%), and distant metastasis: 21 cases (52.5%).
7. Factors related to morta lity were then evaluated for patients who died. Histologically poorly differentiated (G3) disease, lymphonode metastasis, and tumor infiltration deeper than 2/3 of the uterine musclare layer were closely associated with mortality. Taking these findings together, the degree of histological differentiation was found to be the most important prognos tic factor.
8. Tumor metastasis was frequently observed in distant organs in patients with poorly diffe rentiated disease and in the peritoneal cavity in patients with tumo rinfiltration deep in the muscular layer of the uterus. Most of the recurrences were discovered three years after the ini tial diagnosis.
9. Radiation therapy was primarily used to prevent postoperative recurrence, and chemotherapy (primarily consisting of cisplatin (CDDP)) has been employed concomitantly since 1986. Chemotherapy was effective in 60% of patients with canceous peritonitis, but less effective in patients with local recurrence or distant metastasis. In particular, chemotherapy was usually ineffective in patients with poorly differentiated (G3) disease. The findings presented adove indicated that early detection of endometrial carcinoma and improvement