[Prognostic factors in diagnosed endometrial cancers determining the type of radical surgery]

Abstract

Aim: Our aim was to research and evaluate for 10 years period the most important prognostic factors, related and determining the choice of suitable type of radical surgical treatment. It was performed in diagnosed endometrial cancer patients.

Material and methods: We researched 460 patients with endometrial cancer for 10 years period. All of them were operated by radical programme. We evaluated the following prognostic factors: stage, age, histological type, tumor grading, invasion of the tumor in myometrium, tumor volume, peritoneal cytology, LVSI, hormonal receptor status, nuclear grading, DNA--ploidy, the extent of the lymph node dissection (number of lymph nodes) and specific genetic alterations connected with endometrial cancers.

Results: The surgical determined stage was the most important prognostic factor. The age was independent factor. The histological type was very important prognostic factor--the endometrioid cancers were with better survival rate (89%) in comparison with the rare papillary-serous and clear cell cancers (30%). The tumor grading and myometrical invasion had a very important prognostic significance. When the patients were with grade 3 and infiltration in the outer third of myometrium--the positive pelvic lymph nodes were 30% and the paraaortal--20%. The tumor volume according to us is an independent prognostic factor. When the diameter of the tumor was less than 2 cm--the metastases in the lymph nodes were 3% and when the diameter was more than 2 cm--the metastases were 18%. If the tumor volume occupied the whole endometrial cavity and invasion in myometrium was deep, we had 40% metastases in the lymph nodes. The peritoneal cytology had a relative risk. The LVSI was independent prognostic factor. The ER and PR were independent prognostic factors. The nuclear grading--according to our results is a significant prognostic factor. The aneuploidy was the strongest independent factor for bad survival after age and stage. The extent (the volume) of the lymph node dissection was considered as an independent prognostic factor. In type I endometrioid endometrical cancers we evaluated the microsatelite instability and mutations in PIEN, pikCA, etc. The non estrogen related type 2 nonendometrioid endometrial cancers (serous, clear cell) showed mutations in P53 gene and chromosomal instability.

Discussion: Researching and evaluating the prognostic factors for endometrial cancers, we wanted to help and determine the best surgical treatment (the extent, the need for pelvic and paraaortal lymph node dissection).

Conclusions: The radical surgical treatment with lymph node dissection gives better survival rate, as in low risky groups as well in high risky groups of endometrial cancers. The extent (the number of the lymph nodes) is an independent prognostic factor.