Virchows Arch (2013) 462:289296

DOI 10.1007/s00428-013-1382-8

ORIGINAL ARTICLE

Poor prognosis of uterine serous carcinoma compared

with grade 3 endometrioid carcinoma in early stage patients
Ji Young Park & Joo-Hyun Nam & Young-Tak Kim &
Yong-Man Kim & Jong-Hyeok Kim & Dae-Yeon Kim &
Insuk Sohn & Shin-Wha Lee & Chang Ohk Sung &
Kyu-Rae Kim

Received: 18 October 2012 / Revised: 22 January 2013 / Accepted: 4 February 2013 / Published online: 17 February 2013
# Springer-Verlag Berlin Heidelberg 2013

Abstract Difference in prognosis between grade 3 endometrioid carcinoma (G3EC) of the endometrium and uterine serous carcinoma (USC) is controversial. In this study, we further
evaluated the difference in prognosis, if any, between G3EC
(n=61) and USC (n=47) on a total of 565 patients with
endometrial cancer. In addition, meta-analysis was performed
using data from seven previous publications (n=8,637) and
from the Asan Medical Center (n=108). Regarding the cases
from our institution, USC tended to occur in older patients
(65 years) than G3EC (P=0.011). Deep myometrial invasion
(more than or equal to half) was more frequently identified in
G3EC (36/61, 59.0 %) than in USC (17/47, 36.2 %) (P=
0.021). Between patients with early stage G3EC and USC
(stages I and II), there were no significant differences in any
clinicopathological parameter, but there was a significant difference in overall survival (P=0.017) that was not found in
advanced stage (P=0.588). USC was an independent prognostic factor for poor overall survival (hazard ratio, 6.125; P=
0.030) in early stage patients. In the meta-analysis on 5-year
survival in patients with early stage cancers, which also included our study results, a higher relative risk (1.92, 95 % CI 1.62
2.27) was demonstrated in USC than in G3EC (P<0.001). In
J. Y. Park : C. O. Sung (*) : K.-R. Kim
Department of Pathology, Asan Medical Center,
University of Ulsan College of Medicine,
Seoul, Republic of Korea
e-mail: co.sung@amc.seoul.kr
J.-H. Nam : Y.-T. Kim : Y.-M. Kim : J.-H. Kim : D.-Y. Kim :
S.-W. Lee
Department of Obstetrics and Gynecology, Asan Medical Center,
University of Ulsan College of Medicine,
Seoul, Republic of Korea
I. Sohn
Samsung Cancer Research Institute, Seoul, Republic of Korea

conclusion, our study reveals that USC is associated with a

poorer prognosis compared with G3EC, only in patients with
early stage carcinoma, suggesting that different treatment strategies should be considered according to the histologic type in
order to improve treatment outcome.
Keywords Endometrial carcinoma . Grade . Serous .
Endometrioid . Prognosis
Abbreviations
USC
Uterine serous carcinoma
ECCC Endometrial clear cell carcinoma
G3EC Grade 3 endometrioid carcinoma

Introduction
Endometrial carcinoma is the seventh most common cancer
in women worldwide and the incidence has been rising due
to an increasing population of obese women [14]. A dualistic model of endometrial tumorigenesis and classification
(type I and type II endometrial cancer) has been widely
accepted [5, 6]. Type I endometrial carcinoma arises in a
setting of endometrial hyperplasia associated with unopposed estrogen stimulation and shows mainly endometrioid
histology. On the other hand, type II endometrial carcinoma
is associated with endometrial atrophy, is devoid of estrogen
excess, and includes high-grade carcinomas with a nonendometrioid histology, including uterine serous carcinoma
(USC), endometrial clear cell carcinoma (ECCC), and
mixed types of both [5, 7, 8]. Molecular alterations are also
considerably distinct between these two tumor types. Type I
endometrial carcinoma involves mutations in PTEN, K-ras,
-catenin, PIK3CA, and microsatellite instability, whereas
type II endometrial carcinoma frequently shows aneuploidy,