Clinical outcome in endometrial cancer

Patients with endometrial carcinoma (N = 1113) were treated by conventional therapy, using surgery and radiotherapy, complemented by daily administration of 100 mg oral medroxyprogesterone acetate (MPA) for a 2-year period. Only 7.3% of the malignancies were at an advanced clinical stage (III or IV), whereas 75.9 and 16.8% of the carcinomas were detected at clinical stages I and II, respectively. The 5-year survival rate was 71.0% overall, and 77.8%, 61.0, 29.0, and 5.3 for clinical stages I, II, III, and IV, respectively. Patients with anaplastic carcinoma (grade 3) at all clinical stages had significantly lower survival rates than had patients with well-differentiated (grade 1) and moderately differentiated (grade 2) adenocarcinomas. Death of grade 1, grade 2 and grade 3 endometrial carcinoma during the first 2 years occurred in 4.7, 6.8, and 18.2% of cases, respectively, in stage II, indicating that adjuvant MPA cannot totally prevent the progression of endometrial malignancy. The incidence of anaplastic endometrial carcinoma increased with the spread of the disease. It often appeared in patients with low body weight or a second invasive malignancy, but seldom occurred in young patients or patients with diabetes, uterine myoma, or a history of previous estrogen use. The worsened prognosis associated with old age, low body weight, and presence of a second invasive malignancy thus seems at lest partly due to the increased incidence of anaplastic carcinoma, which, on the other hand, did not contribute to the decreased 5-year survival rate of patients with diabetes or severe hypertension.