Prognosis Trend of Grade 2 Endometrioid Endometrial Carcinoma: Toward Grade 1 or 3?
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ORIGINAL ARTICLE
Prognosis Trend of Grade 2 Endometrioid Endometrial Carcinoma: Toward Grade 1 or 3? Ghanim Khatib 1 & Umran Kucukgoz Gulec 1 Mehmet Ali Vardar 1
&
Ahmet Baris Guzel 1
&
Emine Bagir 2
&
Semra Paydas 3
&
Received: 15 May 2020 / Accepted: 27 May 2020 # Arányi Lajos Foundation 2020
Abstract Although the prognostic significance of grade in endometrial cancer is well known, grade 2 cases have not been evaluated separately in most of the previous studies. In this study, we aim to investigate whether the oncologic outcomes of grade 2 endometrioid endometrial carcinomas trend towards grade 1 or 3 tumors. Patients’ records and pathological reports were reviewed retrospectively and eligible patients with endometrioid endometrial carcinoma were determined and distributed into 3 groups according to their 1988 International Federation of Gynecology and Obstetrics (FIGO) grade. Groups’ characteristics and oncologic outcomes were compared. Differences between grades were tested with z-test and adjusted by Bonferroni method. Kaplan–Meier method was performed for the survival analysis. In total, 776 patients of endometrioid endometrial carcinoma were included in this study. Mean follow-up time was 52 ± 14 months. Patients’ mean age was 56.3 ± 10.8 years. Even though grade 2 endometrioid endometrial carcinomas were different from both grade 1 and 3 in terms of the pathological features, survival analyses demonstrated that their oncologic outcomes trended towards grade 1. The grade was determined as an independent prognostic factor for overall survival (OS). The interobserver reproducibility will be improved among pathologists by combining FIGO grade 1 and 2 endometrioid endometrial carcinomas, while prognosis prediction is not likely to be affected. Keywords Endometrioid endometrial carcinoma . FIGO grade . Oncologic outcomes . Interobserver reproducibility
Introduction * Ghanim Khatib [email protected] Umran Kucukgoz Gulec [email protected] Ahmet Baris Guzel [email protected] Emine Bagir [email protected] Semra Paydas [email protected] Mehmet Ali Vardar [email protected] 1
Department of Obstetrics and Gynecology Faculty of Medicine, Çukurova University, 01330 Adana, Turkey
2
Department of Pathology, Division of Gynecologic Pathology, Faculty of Medicine, Çukurova University, 01330 Adana, Turkey
3
Department of Medical Oncology, Faculty of Medicine, Çukurova University, 01330 Adana, Turkey
The International Federation of Gynecology and Obstetrics (FIGO) ternary grading system is the most widespread system used for grading the endometrioid endometrial cancers [1]. The prognostic significance of the tumor grade has been previously described in various studies [2, 3]. Nevertheless, grade 2 tumors were combined with grade 1 and compared together with grade 3 tumors in most of these studies [2, 4]. Clearly, favorable prognosis is expected for grade 1 endometrioid endometrial cancers while the opposite is expected for grade 3 tumors [2, 4, 5]. However, for grade 2 endometrioid carcinomas, there a
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