Selection of tumors with a poor prognosis in operable carcinoma of the endometrium

A retrospective review of 405 patients with operable cancer of the endometrium tested the hypothesis that histological grading might serve to select patients with a poor prognosis for additional external radiation. Deaths from disease by the fifth anniversary were 10 times higher (28/109 - 26%) among patients in the poorly differentiated group - who made up 27% of those assessed. There were 7/288 deaths (2.5%) in the well-differentiated group. A sample of 114 curettage specimens from the above cases, graded without knowledge of the clinical findings, gave a similar result. The FIGO grading system has the advantage of having well-defined dividing lines between grades 1, 2 and 3. However, its value in clinical practice is limited, since the prognostic watershed between well-differentiated and poorly differentiated cases falls well within grade 2. The separation between grade 1 and hyperplasia is also poorly defined and may affect the interpretation of oestrogen studies in relation to endometrial cancer incidence.