Papillary serous and clear cell type lead to poor prognosis of endometrial carcinoma in black women

Abstract

Objective: To investigate the significance of race and histologic type as prognostic factors in endometrial carcinoma.

Methods: We conducted a retrospective review of the medical records of all patients diagnosed with endometrial cancer from 1982 to 1995. Patients' clinical and pathologic characteristics were analyzed.

Results: The sample consisted of 401 patients, 59.9% (N = 229) were blacks and 40.1% (N = 153) were non-blacks. The mean age was 63.7 +/- 11.6 years. The histologic subtypes of endometrial carcinoma included 346 endometrioid (86.3%), 42 papillary serous (10.5%), and 13 clear cell (3.2%) adenocarcinomas. We found 79% of endometrioid adenocarcinomas were stage I or II compared to 26% of papillary serous tumors and 58% of clear cell carcinomas (P < 0.01). Eighty-eight percent of patients with papillary serous and 77% of patients with clear cell cancers were black (P < 0.01). Within each stage, patients were treated similarly irrespective of cell type or race. Five-year survival for endometrioid, papillary serous and clear cell adenocarcinomas was 69, 18, and 25%, respectively (P < 0.01). Black women had poorer 5-year survival (56%) than non-black women (71%). In multivariate analyses using age, stage, race, and histology, only stage and histology were independent risk factors for survival.

Conclusions: Patients with papillary serous and clear cell endometrial cancer were more likely to be black, present at an advanced stage of disease, and have poor survival compared to patients with endometrioid adenocarcinoma. This may help to explain the poorer survival reported in blacks with endometrial cancer.