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Pathologic Prognostic Factors in Endometrial Carcinoma (Other Than Tumor Type and Grade)
Naveena Singh1, Lynn Hirschowitz, Richard Zaino
1Department of Cellular Pathology, Barts Health NHS Trust, London (N.S.) Department of Cellular Pathology, Birmingham Women's NHS Trust, Birmingham (L.H.) Department of Pathology, Belfast Health and Social Care Trust, Belfast (W.G.M.), UK Division of Anatomic Pathology, Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania (R.Z.) Department of Pathology, Mexico City Hospital of Oncology, Mexico City, Mexico (I.A.-C.) Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada (M.A.D.) Department of Pathology, Wayne State University, Detroit, Michigan (R.A.-F.) Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.E., A.M.) Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School (J.L.H.) Department of Pathology, Brigham and Women's Hospital, Harvard Medical School (M.N.) Department of Pathology, Massachusetts General Hospital, Harvard Medical School (E.O.), Boston, Massachusetts Division of Gynecologic, Breast & Perinatal Pathology, University Hospital Leipzig, Leipzig (L.-C.H.) Institute of Pathology, University Hospital of Tübingen, Tübingen (A.S.), Germany Department of Anatomical Pathology, University of Maryland, College Park, Maryland (O.I.) Pathological Oncology Group and Pathology Department, University Hospital of Arnau de Vilanova, Lleida (X.M.-G.) Department of Pathology, Hospital Clinic of Barcelona, ISGlobal, Barcelona Center for International Health Research, University of Barcelona, Barcelona (J.O.), Spain Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan (Y.M.) Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (V.P.) Department of Pathology, Women and Infants Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island (M.R.Q.) Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (C.M.Q.) Department of Pathology, University of California, San Francisco, San Francisco, California (C.Z.).
Abstract:
Although endometrial carcinoma (EC) is generally considered to have a good prognosis, over 20% of women with EC die of their disease, with a projected increase in both incidence and mortality over the next few decades. The aim of accurate prognostication is to ensure that patients receive optimal treatment and are neither overtreated nor undertreated, thereby improving patient outcomes overall. Patients with EC can be categorized into prognostic risk groups based on clinicopathologic findings. Other than tumor type and grade, groupings and recommended management algorithms may take into account age, body mass index, stage, and presence of lymphovascular space invasion. The molecular classification of EC that has emerged from the Cancer Genome Atlas (TCGA) study provides additional, potentially superior, prognostic information to traditional histologic typing and grading. This classifier does not, however, replace clinicopathologic risk assessment based on parameters other than histotype and grade. It is envisaged that molecular and clinicopathologic prognostic grouping systems will work better together than either alone. Thus, while tumor typing and grading may be superseded by a classification based on underlying genomic abnormalities, accurate assessment of other pathologic parameters will continue to be key to patient management. These include those factors related to staging, such as depth of myometrial invasion, cervical, vaginal, serosal surface, adnexal and parametrial invasion, and those independent of stage such as lymphovascular space invasion. Other prognostic parameters will also be discussed. These recommendations were developed from the International Society of Gynecological Pathologists Endometrial Carcinoma project.
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