Prognostic Implications of Depth of Cervical Stromal Invasion in Type 1 and Type 2 Endometrial Cancers

Document Type

Conference Proceeding

Publication Date


Publication Title

Mod Pathol


Background: Cervical stromal invasion (CSI) by endometrial carcinoma (EC) signifies worse prognosis needing adjuvant therapy. Prognostic implications of this invasion are unknown. We investigate in this study the prognostic significance of depth and pattern of CSI in patients with type 1 and type 2 EC. Design: This is a retrospective study of patients with FIGO stage 2 EC, treated in 1991 -2019, grouped into type 1 and 2 ECs based on histotype. After IRB approval, we assessed microscopic depth of CSI (distance from cervical surface to deepest point of invasion in cervical stroma), and pattern of invasion (based on endocervical adenocarcinoma patterns A, B, and C). Descriptive analysis and Cox regression models were produced. Results: Materials were available on 50 type 1 and 52 type 2 ECs. Clinical characteristics are summarized in table 1. For type 1 EC, median (min, max) depth of CSI was 3.5(0.5-20.0) mm, with median percentage invasion of 33.3(6.7-100)%. CSI to ≥2/3 of stroma was found in 9(18%) cases, being associated with worse overall survival (OS) on univariable (HR, 4.36; p-value, 0.02) and multivariable (HR, 8.27; p-value, 0.01) analysis. CSI of 4.0 mm or more, found in 24(48%) cases, was associated with non-significant tendency for worse OS on univariable analysis, but on multivariable analysis, it correlated with worse OS (Figure 1a). The odds of recurrence was nearly 3.5 times higher with each 5-mm increase in CSI depth on univariable(OR, 3.46; 95% CI, 1.21-9.90; p-value, 0.021) and multivariable(OR, 4.11; 95% CI, 1.11-15.21; p-value, 0.034) analyses. However, the study was not powered to examine the correlation of a specific depth of invasion with recurrence rates (N=5 with recurrence). Pattern of invasion was not correlated with different OS or recurrence rate on univariable and multivariable analyses. For type 2 ECs, median depth of CSI is 5(0.50-17.0) mm, with median percentage invasion to cervical stromal thickness of 43.7(4.6-100)%. Depth and pattern of CSI was not associated with different OS or recurrence rate after examining multiple cut points on univariable and multivariable testing (figure 2) Conclusions: Higher depth of CSI, especially at 2/3 or more, is predictive of worse OS in type 1 ECs and generally correlates with higher recurrence rate. Routine reporting of CSI depth is recommended, and further prospective studies to explore adjuvant treatment adjustment are needed. In contrast, CSI characteristics are not associated with different behavior in type 2 ECs.

PubMed ID

Not assigned.





First Page


Last Page