Skip Navigation LinksHome > November 2013 - Volume 23 - Issue 9 > Redefining Stage I Endometrial Cancer: Incorporating Histolo...
International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0b013e3182a5055e
Uterine Cancer

Redefining Stage I Endometrial Cancer: Incorporating Histology, a Binary Grading System, Myometrial Invasion, and Lymph Node Assessment

Barlin, Joyce N. MD*; Soslow, Robert A. MD; Lutz, Megan MD*; Zhou, Qin C. MS; St. Clair, Caryn M. MD*; Leitao, Mario M. Jr MD; Iasonos, Alexia PhD; Hensley, Martee L. MD; Barakat, Richard R. MD; Matias-Guiu, Xavier MD; Abu-Rustum, Nadeem R. MD

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Abstract

Objective: We propose a new staging system for stage I endometrial cancer and compare its performance to the 1988 and 2009 International Federation of Gynecology and Obstetrics (FIGO) systems.

Methods: We analyzed patients with 1988 FIGO stage I endometrial cancer from January 1993 to August 2011. Low-grade carcinoma consisted of endometrioid grade 1 to grade 2 lesions. High-grade carcinoma consisted of endometrioid grade 3 or nonendometrioid carcinomas (serous, clear cell, and carcinosarcoma). The proposed system is as follows:

IA. Low-grade carcinoma with less than half myometrial invasion

IA1: Negative nodes

IA2: No nodes removed

IB. High-grade carcinoma with no myometrial invasion

IB1: Negative nodes

IB2: No nodes removed

IC. Low-grade carcinoma with half or greater myometrial invasion

IC1: Negative nodes

IC2: No nodes removed

ID. High-grade carcinoma with any myometrial invasion

ID1: Negative nodes

ID2: No nodes removed

Results: Data from 1843 patients were analyzed. When patients were restaged with our proposed system, the 5-year overall survival significantly differed (P < 0.001): IA1, 96.7%; IA2, 92.2%; IB1, 92.2%; IB2, 76.4%; IC1, 83.9%; IC2, 78.6%; ID1, 81.1%; and ID2, 68.8%. The bootstrap-corrected concordance probability estimate for the proposed system was 0.627 (95% confidence interval, 0.590–0.664) and was superior to the concordance probability estimate of 0.530 (95% confidence interval, 0.516–0.544) for the 2009 FIGO system.

Conclusions: By incorporating histological subtype, grade, myometrial invasion, and whether lymph nodes were removed, our proposed system for stage I endometrial cancer has a superior predictive ability over the 2009 FIGO staging system and provides a novel binary grading system (low-grade including endometrioid grade 1–2 lesions; high-grade carcinoma consisting of endometrioid grade 3 carcinomas and nonendometrioid carcinomas).

© 2013 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.

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