Prognostic significance of depth and pattern of cervical stromal invasion in type 1 endometrial carcinoma
Alkamachi B, Zhu S, Elshaikh M, and Allo G. Prognostic significance of depth and pattern of cervical stromal invasion in type 1 endometrial carcinoma. Modern Pathology 2020; 33(3):1005-1006.
Background: The prognostic significance of cervical stromal invasion (CSI) by endometrial carcinoma is well established, and patients with this form of invasion are offered similar adjuvant therapy. It is not clear whether characteristics of this form of invasion have prognostic implications. We aim in this study to investigate the prognostic significance of depth and pattern of cervical stromal invasion in patients with type 1 endometrial carcinoma. Design: This is a retrospective study of patients with type 1, FIGO stage 2 endometrial cancer, who were treated at our institution between 1991 and 2019. After IRB approval, we assessed microscopic depth of CSI (measured as distance from cervical surface to deepest point of invasion within cervical stroma), cervical stromal thickness, and pattern of invasion (based on endocervical adenocarcinoma previously described patterns A, B, and C). Clinical data were collected from the medical records. Descriptive analysis and Cox regression models were produced. Results: Material and data were available on 50 patients. Median age at diagnosis was 65(41-91) years, of which 30 patients had FIGO grade 1, 23 showed <50% myometrial invasion, 11 had angioinvasion, 40 had underwent lymph node dissection, and 42 received adjuvant radiation. Median depth of CSI was 3.5(0.5-20.0) mm, with median percentage invasion to cervical stromal thickness of 33.3(6.7-100)%. CSI to >2/3 of cervical stroma was found in 8 (16%) of patients, and was associated with worse overall survival (OS) in univariable analysis (HR, 0.22; 95% CI, 0.06-0.75), and after controlling for age, race, grade, depth of myometrial invasion, angioinvasion, peritoneal washings, and adjuvant radiotherapy (HR, 0.08; 95% CI, 0.01-0.53). CSI of 5.0 mm or more, found in 16(32%) patients, was associated with tendency towards worse OS (HR, 3.1; 95% CI, 0.96 - 10.2), while CSI of 50% cervical stroma or more (n=17, 34%) or patterns of invasion were not associated with different OS on univariable analysis. Recurrence was present in 5(10%) of patients, significantly higher in those with >1/3 CSI (LH, 7.1; 0=0.008). (Figure presented) Conclusions: A small subset of type 1, FIGO stage 2 endometrial cancers shows extension to more than 2/3 of cervical stroma and exhibits worse overall survival. Subcategorization of stage 2 and therapy tailoring may be indicated in these patients. Further studies are needed.