Stage 3B adenocarcinoma of the endometrium: a clinicopathologic study

The aims of this study were to evaluate the management of Stage IIIB adenocarcinoma of the endometrium (EAC) and to determine the utility of the FIGO classification as it applies to patients with this category of disease and make recommendations on management.

A retrospective review was undertaken of the database of the Queensland Centre for Gynaecological Cancer (QCGC) from January 1982 to December 1996. The records of all patients recorded as having Stage IIIB EAC were retrieved. After validation of the designated staging, the contemporary disease status was determined and clinicopathological details were extracted from case notes.

Of a total of 1940 patients with EAC treated by QCGC over the 15-year study period, 14 (0.7%) patients met the inclusion criteria. Nine patients (64%) presented with postmenopausal bleeding and the remaining patients presented with a variety of symptoms. There was no statistically significant difference in age between the study group and other patients with advanced stage EAC ranging from Stage IIIA to Stage IVB disease. Survival of patients with Stage IIIB disease was statistically significantly worse than that of patients with Stage IIIA disease, but was not statistically significantly different from patients with Stage IIIC, IVA, or IVB. While all patients had the unifying characteristic of metastatic disease in the vagina, the true extent of disease could not be determined by a full surgical staging procedure. Such optimal surgery was contraindicated in all patients because of the presence of significant coexisting medical conditions. Consequently, treatment was highly individualized.

Stage IIIB adenocarcinoma of the endometrium is an uncommon condition. Similar to other substages of advanced disease, it is associated with a poor prognosis and requires individualized management. The argument is presented that this substage could be eliminated and included with Stage IIIC disease.