Clinicopathological features and prognosis of synchronous endometrial and ovarian carcinoma

Clinicopathological features and prognosis of synchronous endometrial and ovarian carcinoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinicopathological features and prognosis of synchronous endometrial and ovarian carcinoma Wenli Gan, Ce Bian, Jitong Zhao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8116283/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study analyzed clinicopathological characteristics and survival outcomes in 48 patients with synchronous endometrial and ovarian carcinoma (SEOC) treated at West China Second University Hospital (2015–2022). Kaplan-Meier and log-rank tests compared survival differences; multivariate Cox regression identified independent prognostic factors. Most patients were premenopausal (87.5%) with a median age of 47 years. The median BMI was 23.2 kg/m² (range: 16.4–35.2 kg/m²). The most common presenting symptom was vaginal bleeding. Histopathological analysis revealed that both carcinomas exhibited endometrioid histology in 38 cases (79.2%), were grade 1 in 23 cases (47.9%), and were FIGO stage I in 24 cases (50%). Postoperative adjuvant therapy was administered to 43 patients (89.6%). Survival analysis revealed the following significant prognostic factors: ovarian histologic type (p = 0.008), SEOC histologic subtype (p = 0.016), SEOC tumor grade (p = 0.029), ovarian cancer stage (p = 0.032), lymph node metastasis status (p < 0.001), and performance of lymphadenectomy (p = 0.029). These results shed light on SEOC typically presents with early-stage, low-grade tumors and favorable prognosis. Preoperative imaging and tumor marker assessment provide critical guidance for surgical planning. Lymph node metastasis, ovarian histology and stage critically guide adjuvant therapy. Systematic lymphadenectomy benefits in early-stage disease require further investigation. Endometrial neoplasia Ovarian neoplasia Synchronous Pathological characteristics Prognostic Figures Figure 1 Figure 2 1. Introduction Synchronous primary carcinomas of the female reproductive system are rare, accounting for 0.63% to 1.7% of all gynecologic malignancies. Among these, synchronous endometrial and ovarian carcinoma (SEOC) is the most frequent subtype, representing 40%–51.7% of cases[ 1 – 3 ]. SEOC occurs in less than 3% of ovarian cancer patients [ 4 , 5 ] and 3.8%–5.5% of endometrial cancer cohorts [ 6 , 7 ]. Due to nonspecific clinical presentations, most SEOC cases are diagnosed postoperatively through pathological examination, though diagnostic criteria remain controversial. Current evidence on SEOC is limited, and standardized global management guidelines are lacking. Radical surgery constitutes the primary treatment, involving comprehensive surgical staging (hysterectomy, bilateral salpingo-oophorectomy, pelvic/para-aortic lymphadenectomy, and omentectomy) [ 5 ]. Studies suggest favorable overall survival, particularly for tumors confined to the uterus and ovaries, which exhibit low recurrence and metastasis rates and may not require adjuvant therapy[ 8 , 9 ]. However, the absence of preoperative diagnostic specificity and challenges in pathological differentiation often lead to misclassification as Stage III endometrial or Stage II ovarian cancer. This may result in overtreatment with unnecessary adjuvant chemoradiation. Therefore, establishing evidence-based diagnostic and therapeutic guidelines through rigorous research is imperative to optimize patient outcomes. This study analyzes clinicopathological characteristics and prognostic factors in 48 SEOC patients to inform personalized management strategies. 2. Methods 2.1 Materials Approved by the Ethics Committee of West China Second University Hospital (No. 2023 − 140), this retrospective study analyzed 48 SEOC cases with complete clinicopathological and follow-up data treated between January 2015 and December 2022. The inclusion criteria included: (1) age ≥ 18 years; (2) histopathological confirmation of synchronous primary endometrial and ovarian carcinomas according to Scully's diagnostic criteria[ 10 ]; (3) availability of complete clinicopathological data and reliable follow-up. Exclusion criteria comprised: (1) incomplete medical records or unreliable follow-up; (2) non-epithelial malignancies (borderline ovarian tumors, sex cord-stromal tumors, mesenchymal tumors, mixed epithelial-stromal tumors, Brenner tumors, uterine sarcomas, or carcinosarcomas); (3) primary/secondary surgeries were performed outside our institution. Comprehensive clinicopathological parameters were extracted from medical records, including: patient demographics (age, BMI, reproductive history, menopausal status, family history, comorbidities); preoperative assessments (imaging: ultrasound/CT/MRI; tumor markers: CA125/CA19-9); surgical details (approach, intraoperative findings, residual tumor status); adjuvant therapy (chemotherapy regimens/cycles); oncologic outcomes (recurrence timing/location, survival data); and pathological characteristics (histologic type, grade, FIGO stage, tumor dimensions, lymph node metastasis, lymphovascular space invasion (LVSI), depth of myometrial invasion (MI), cervical stromal involvement, presence of endometrial atypical hyperplasia or ovarian endometriosis, and immunohistochemistry (p53, ER, PR, MMRd). 2.2 Diagnosis All histopathological slides underwent centralized review by at least two pathologists. SEOC diagnosis was confirmed using Scully's criteria [ 10 ] (Table 1 ), integrating clinical history and auxiliary examinations. Patients were stratified into low-risk and high-risk groups based on histologic type, differentiation, and FIGO stage. Low-risk group: Patients with dual endometrioid histology, low-grade differentiation (G1), and FIGO Stage I disease at both sites. High-risk group: Patients exhibiting Non-endometrioid histology, high-grade differentiation (Non-G1), or advanced-stage (Non-Stage I) disease at either site. Table 1 Histopathological diagnosis and differentiation criteria for concurrent endometrial carcinoma and ovarian cancer Independent Primary Tumors Endometrial Primary Ovarian Secondary Ovarian Primary Endometrial Secondary 1.Histologic dissimilarity of the tumors 1.Histologic similarity of the tumors 1. Histologic similarity of the tumors 2. No or only superficial myometrial invasion of endometrial tumor 2. Large endometrial tumor - small ovarian tumor(s) 2. Large ovarian tumor - small endometrial tumor 3.No vascular space invasion of endometrial tumor 3. Atypical endometrial hyperplasia additionally present 3. Ovarian endometriosis present 4.Atypical endometrial hyperplasia additionally present 4. Deep myometrial invasion a. Direct extension into adnexa b. Vascular space invasion in myometrium 4. Location in ovarian parenchyma 5.Absence of other evidence of the spread of endometrial tumor 5. Spread elsewhere in typical pattern of endometrial carcinoma 5. Direct extension from ovary predominantly into outer wall of uterus 6.Ovarian tumor unilateral (80 to 90 percent of cases) 6. Ovarian tumors bilateral and/or multinodular 6. Spread elsewhere in the typical pattern of ovarian carcinoma 7.Ovarian tumor located in parenchyma 7. Hilar location, vascular space invasion, surface implants, or combination in ovary 7. Ovarian tumor unilateral (80 to 90 percent of cases) and forming single mass 8.No vascular space invasion, surface implants, or predominant hilar location in ovary 8. Ovarian endometriosis absent 8. No atypical hyperplasia in endometrium 9.Absence of other evidence of spread of ovarian tumor 9. Aneuploidy with similar DNA indices or diploidy of both tumors* 9. Aneuploidy with similar DNA indices or diploidy of both tumors* 10.Ovarian endometriosis present 10. Similar molecular genetic or karyotypic abnormalities in both tumors 10. Similar molecular genetic or karyotypic abnormalities in both tumors 11. Different ploidy or DNA indices, if aneuploid, of the tumors* 12.Dissimilar molecular genetic or karyotypic abnormalities in the tumors *The possibility of tumor heterogeneity must be considered in the evaluation of the ploidy findings. 2.3 Staging All 48 patients underwent surgical management. Due to the retrospective nature of this study (2015–2022) where molecular profiling was not routinely performed, endometrial cancer staging followed the 2009 FIGO criteria and ovarian cancer staging adhered to the 2014 FIGO system. SEOC stage I was strictly defined as FIGO stage I disease in both endometrial and ovarian lesions. 2.4 Treatment All 48 SEOC patients underwent radical surgery, comprising total hysterectomy, bilateral salpingo-oophorectomy, with or without omentectomy, with or without pelvic lymphadenectomy, with or without para-aortic lymph node sampling/dissection, with or without appendectomy. Given the rarity of this malignancy and limited literature, adjuvant treatment plans were formulated through multidisciplinary tumor board discussions based on intraoperative findings and final pathology, incorporating patient-centered shared decision-making. 2.5 Follow-up Patient follow-up was conducted through outpatient clinic reviews and telephone interviews. The survival period was calculated in months, with the surgery date as the starting point and December 31, 2024, as the cutoff date. Progression-free survival (PFS) was defined as time from surgery to disease recurrence, metastasis, or death. Cases without events were censored at the last follow-up. Overall survival (OS) was defined as time from surgery to all-cause death. Surviving patients were censored at the last follow-up. Follow-up was conducted once every 3 months for the first 2 years postoperatively, once every 6 months during years 3–5, and annually thereafter. The follow-up assessments include Pelvic examination, serum tumor markers (CA125, CA199), and imaging (CT, vaginal color Doppler ultrasound). 2.6 Statistical method Statistical analyses were performed using IBM SPSS Statistics 27. Continuous variables are presented as median (range); categorical variables as frequency (%). Kaplan-Meier curves with log-rank tests compared to survival between subgroups. Variables with p < 0.05 were entered into multivariate Cox proportional hazards regression. p < 0.05 was considered statistically significant. 3. Results 3.1 The basic clinical characteristics of SEOC We identified 48 patients who were diagnosed with SEOC by surgery and histopathology. The median age at diagnosis was 47 years (range: 27–59), with median BMI 23.2 kg/m² (range: 16.4–35.2). 3 patients (6.3%) were obese (BMI ≥ 30 kg/m²), 12 (25.0%) were nulliparous, and 42 (87.5%) were premenopausal. Vaginal bleeding was the most common presenting symptom (22 abnormal uterine bleeding and 4 postmenopausal bleeding. Preoperative imaging revealed: 13 patients (27.1%) with both ovarian and endometrial lesions, 28 (58.3%) with isolated ovarian lesions, 5 (10.4%) with isolated endometrial lesions, and 2 (4.2%) without detectable lesions. The median preoperative CA125 levels were 276.1 U/mL (range: 5.2–4146.6 U/mL), elevated (> 35 U/mL) in 39 patients (81.3%). The median preoperative CA199 levels were 237.5U/mL (range 5.3–36,539.1 U/mL), elevated (> 34.1 U/mL) in 37 patients (77.1%). The patients' baseline characteristics are detailed in Table 2 . Table 2 clinicopathologic feature s of patients clinicopathologic features Number % Age ≤ 45y 21 43.8 >45y 27 56.3 BMI <18.5 kg/m 2 3 6.3 18.5-24.9kg/m 2 29 60.4 25-29.9 kg/m 2 13 27.1 ≥ 30kg/m 2 3 6.3 Parity Nulliparous 12 25 Multipara 36 75 Menopausal state Postmenopausal 6 12.5 Premenopausal 42 87.5 Initial symptom Vaginal bleeding 26 54.1 Abdominal pain /bloating 15 31.3 No clinical symptoms 7 14.6 Preoperative imaging Ovary (+) Endometrium (-) 28 58.3 Ovary (-) Endometrium (+) 5 10.4 Ovary (+) Endometrium (+) 13 27.1 Ovary (-) Endometrium (-) 2 4.2 CA125 U/mL <35 9 18.8 ≥ 35 39 81.2 CA 199 U/mL <34.1 11 22.9 ≥ 34.1 37 77.1 Preoperative D&C Yes 17 35.4 No 31 64.6 Lymph node dissection Yes 42 87.5 No 6 12.5 Cytology of ascites Negative 27 56.2 Positive 9 18.8 Missing 12 25 Lymph node metastasis No 38 79.2 Yes 4 8.3 Missing 6 12.5 MI No 9 18.8 <1/2 36 75 ≥ 1/2 3 6.2 Cervical stromal invasion Yes 6 12.5 No 42 87.5 LVSI Yes 7 14.6 No 41 85.4 Atypical endometrial hyperplasia Yes 21 43.8 No 27 56.3 Ovarian endometriosis Yes 18 37.5 No 30 62.5 Adjuvant therapy Chemotherapy 38 79.2 Chemotherapy + Radiation 5 10.4 No 5 10.4 Endometrial histological type Endometrioid 47 97.9 Mixed 1 2.1 Endometrial histological grade G1 33 68.8 G2 13 27.1 G3 2 4.2 Endometrial FIGO stage Ⅰ 39 81.3 Ⅱ 4 8.3 Ⅲ 4 8.3 Ⅳ 1 2.1 Ovarian histological type Endometrioid 39 81.2 Mucinous 1 2.1 Serous 2 4.2 Clear cell 2 4.2 Mixed 4 8.3 Ovarian histological grade G1 28 58.3 G2 12 25.0 G3 8 16.7 Ovarian FIGO stage Ⅰ 30 62.5 Ⅱ 13 27.1 Ⅲ 4 8.3 Ⅳ 1 2.1 BMI: Body Mass Index, underweight: <18.5 kg/m 2 , normal༚18.5-24.9kg/m 2 , overweight༚25-29.9 kg/m 2 , obese༚≥30kg/m 2 . D&C: Dilation and Curettage. MI: Myometrial invasion. LVSI: Lymph Vascular Space Invasion. FIGO: Federation of International of Gynecology and Obstetrics. 3.2 Pathological characteristics of SEOC The pathological features of endometrial cancer are detailed in Table 2 : Histopathology revealed endometrioid carcinoma in 47 cases (97.9%) and mixed adenocarcinoma in 1 case (2.1%, comprising 60% high-grade serous, 30% clear cell, and 10% grade 1 endometrioid components). Tumor grading distribution: 33 G1 (68.8%), 13 G2 (27.1%), 2 G3 (4.2%). FIGO staging: Stage I (81.3%: 38 IA + 1 IB), Stage II (8.3%), Stage IIIA (8.3%), Stage IVB (2.1%). Myometrial invasion depth: ≥1/2 in 3 cases (6.2%), < 1/2 in 36 (75%), absent in 9 (18.8%). Cervical stromal invasion was present in 6 patients (12.5%) and LVSI in 7 (14.6%). Concurrent endometrial atypical hyperplasia was identified in 21 cases (43.8%). The pathological features of ovarian cancer are detailed in Table 2 : Histopathology revealed predominantly endometrioid carcinoma (81.2%, 39/48), with other subtypes including serous (4.2%, 2/48), mucinous (2.1%, 1/48), clear cell (4.2%, 2/48), and mixed adenocarcinomas (8.3%, 4/48: 2 seromucinous, 1 endometrioid-mucinous, 1 clear cell-endometrioid). Tumor grading distribution showed G1 in 58.3% (28/48), G2 in 25% (12/48), and G3 in 16.7% (8/48). FIGO staging comprised Stage I (62.5%: 18 IA, 2 IB, 11 IC), Stage II (27.1%: 2 IIA, 9 IIB, 1 IIC), Stage III (8.3%: 3 IIIA, 1 IIIB), and Stage IVB (2.1%, 1/48). Concurrent ovarian endometriosis was identified in 37.5% (18/48) of cases. The pathological features of SEOC are detailed in Table 3 : Dual endometrioid histology was observed in 79.2% (38/48) of patients, with 47.9% (23/48) having G1 tumors at both sites, and 50% (24/48) had Stage I tumors synchronously at both sites. The microscopic pathological features of SEOC are shown in Fig. 1 . Table 3 Histopathological types of SEOC Histological type of EC Total Endometrioid Mixed Histological type of OC Endometrioid 38 1 39 Mucinous 1 0 1 Serous 2 0 2 Clear cell 2 0 2 Mixed 4 0 4 Total 47 1 48 EC: Endometrial cancer, OC: Ovarian cancer 3.3. Treatment All 48 patients underwent primary surgery comprising hysterectomy with bilateral salpingo-oophorectomy, plus variable combinations of pelvic/para-aortic lymphadenectomy (87.5%), omentectomy (91.7%), and appendectomy (72.9%). Hysterectomy types included infra-fascial (85.4%), modified radical (12.5%), and subtotal (2.1%, due to renal transplant adhesions). Peritoneal cytology was performed in 75% (18.8% positive). Preoperative endometrial cancer diagnosis was confirmed by D&C in 35.4%, while 8.3% were referred after emergency surgery for ovarian pathology. Adjuvant therapy was determined by multidisciplinary review and shared decision-making: 79.2% (38/48) received platinum-based chemotherapy (paclitaxel-carboplatin/cisplatin, 1–8 cycles), 10.4% (5/48) chemoradiation, and 10.4% (5/48) no adjuvant therapy. 3.4 Survival analysis of SEOC With a median follow-up of 59.5 months (cutoff: December 31, 2024), 47 patients (97.9%) completed follow-up. Five deaths and six disease progressions/recurrences occurred. The cohort demonstrated 5-year overall survival of 89.1% and progression-free survival of 87.4%, with mean OS of 108.1 months (95% CI: 99.1-117.1) and mean PFS of 105.8 months (95% CI: 95.9-115.7). Table 4 Univariate analysis affecting the prognosis of SEOC factors 5-year OS(%) P 5-year PFS(%) P Age 0.291 0.647 ≤ 45y 21 95.2 90.5 >45y 27 84.7 85.2 BMI 0.494 0.969 <25 32 87.5 87.5 ≥ 25 16 92.9 87.1 Parity 0.815 0.526 Nulliparous 12 91.7 83.3 Multipara 36 88.3 88.9 Menopausal state 0.076 0.137 Postmenopausal 6 66.7 66.7 Premenopausal 42 92.8 90.4 Initial symptom 0.764 0.513 Vaginal bleeding 26 87.4 84.6 Other 22 90.5 90.5 CA125 0.225 0.220 <35 9 100 100 ≥ 35 39 86.4 84.4 CA 199 0.908 0.713 <34.1 11 90.9 90.9 ≥ 34.1 37 88.6 86.2 Adjuvant therapy 0.422 0.531 yes 43 87.8 88.2 no 5 100 80 Histological type of EC 0.733 0.712 EEC 47 88.9 87.1 Non-EEC 1 100 100 Histological type of OC 0.008 0.031 EOC 39 94.3 92.2 Non-EOC 9 66.7 66.7 Histological type of SEOC 0.016 0.055 EEC/EOC 38 94.2 92.0 Non-EEC/EOC 10 70.0 70.0 Histological grade of EC 0.727 0.971 G1 33 90.8 87.8 Non-G1/G1 15 86.2 86.7 Histological grade of OC 0.066 0.195 G1 28 95.7 92.7 Non-G1/G1 20 80.0 80.0 Histological grade of SEOC 0.029 0.122 G1/G1 23 100 95.7 Non-G1/G1 25 79.6 80.0 Stage of EC 0.255 0.220 Ⅰ 39 86.4 84.4 Ⅱ+Ⅲ+Ⅳ 9 100 100 Stage of OC 0.032 0.132 Ⅰ 30 96.6 93.2 Ⅱ+Ⅲ+Ⅳ 18 75.0 77.8 Stage of SEOC 0.154 0.425 Ⅰ 24 95.7 91.5 Ⅱ+Ⅲ+Ⅳ 24 82.0 83.3 Group of SEOC 0.143 0.532 Low-risk group 14 100 92.9 High-risk group 34 84.7 85.3 MI 0.544 0.512 <1/2 45 88.3 86.5 ≥ 1/2 3 100 100 Cervical stromal invasion 0.597 0.738 positive 6 83.3 83.3 negative 42 89.8 87.9 LVSI 0.084 0.175 positive 7 68.6 71.4 negative 41 92.6 90.1 Lymph node metastasis <0.01 0.007 positive 4 50.0 50 negative 38 97.0 94.7 missing 6 66.7 66.7 Cytology of ascites 0.482 0.676 positive 9 74.1 77.8 negative 27 92.4 88.7 missing 12 91.7 91.7 Lymph node dissection 0.029 0.082 Yes 42 92.4 90.4 No 6 66.7 66.7 EC: Endometrial cancer. OC: Ovarian cancer. SEOC: Synchronous endometrial and ovarian carcinoma. EEC/EOC: Endometrioid Endometrial Cancer/Endometrioid Ovarian Cancer. Non-EEC/EOC: The histological type of cancer foci in any part of the endometrium and ovary is non-endometrioid carcinoma. MI: Myometrial Invasion. LVSI: Lymph Vascular Space Invasion. OS: Overall survival. PFS: Progression-free survival. The comparisons among each group were all indicated as statistically significant with p < 0.05. As detailed in Table 4 , univariate analysis demonstrated significantly reduced 5-year OS in patients with Non-EOC histology ( p = 0.008), Non-EEC/EOC ( p = 0.016), Non-G1/G1 ( p = 0.029), Non-Stage I of OC ( p = 0.032), lymph node metastasis ( p < 0.001), or no lymphadenectomy performed ( p = 0.029). Concurrently, significantly inferior 5-year PFS was associated specifically with Non-EOC histology ( p = 0.031) and lymph node metastasis ( p = 0.007), with all reported associations achieving statistical significance ( p < 0.05). The Kaplan-Meier curves of OS and PFS affected by different factors are shown in Fig. 2 . However, multivariate Cox regression analysis of variables that showed statistically significant differences ( p < 0.05) in the univariate analysis revealed that none of the associated factors demonstrated independent predictive value for the clinical outcomes of SEOC patients (detailed in Table 5 ), with none reaching statistical significance ( p > 0.05). Table 5 Multivariate analysis affecting the prognosis of SEOC factors HR 95%CI P 5-year OS(%) Histological type of OC 95557.978 0.000 ~ 1.679E + 185 0.957 Histological type of SEOC 0.000 0.000 ~ 1.088E + 174 0.944 Histological grade of SEOC 11206471.73 0.000 ~ 5.231E + 34 0.618 Stage of OC 42444.453 0.000 ~ 2.225E + 18 0.509 Lymph node metastasis 316.232 0.000 ~ 7.449E + 12 0.637 Lymph node dissection 149643.948 0.000 ~ 7.040E + 18 0.458 5-year PFS(%) Histological type of OC 3.114 0.471 ~ 20.580 0.238 Lymph node metastasis 3.306 0.443 ~ 24.663 0.244 OC: Ovarian cancer. SEOC: Synchronous endometrial and ovarian carcinoma. OS: Overall survival. PFS: Progression-free survival. 4. Discussion 4.1 Clinical characteristics of SEOC Consistent with prior studies [7, 11, 12], SEOC predominantly affects premenopausal women, with our cohort's median diagnosis age (47 years) aligning with reported ranges (48–50 years) and occurring approximately a decade earlier than single primary endometrial or ovarian cancer [13]. Notably, our data diverged from reported obesity and nulliparity associations [14]: only 25% were nulliparous, and median BMI was 23.2 kg/m² (6.3% obese, BMI ≥ 30 kg/m²). These discrepancies may reflect ethnic, geographic, or sample size variations. Consistent with literatures [5, 11, 12, 14], abnormal vaginal bleeding was the predominant initial symptom (54.2%, 26/48). Although SEOC lacks pathognomonic features, early detection is facilitated by endometrial carcinoma's hallmark symptom—vaginal bleeding—which enabled preoperative histologic diagnosis via Dilation and Curettage ( D&C) in 35.4% of cases, critically informing surgical planning. Serological tumor markers offer referential value; however, preoperative CA125 has limited diagnostic utility for endometrial or ovarian cancer: it may not be elevated in early-stage patients and can be confounded by benign conditions (e.g., infection, endometriosis), being primarily used for treatment monitoring. In this study, 81.3% of SEOC patients exhibited elevated preoperative CA125, aligning with prior conclusions [14], while 77.1% showed CA199 elevation. Their diagnostic performance in SEOC requires further validation with larger sample sizes. 4.2 Imaging manifestations of SEOC Current imaging studies on SEOC remain scarce. Routine modalities include ultrasound, CT, and MRI, detecting uterine masses, endometrial thickening, and other abnormalities. Transvaginal ultrasound, being cost-effective, initially evaluates endometrial/adnexal lesions. An Italian study identified SEOC typically as unilateral ovarian multilocular-solid/purely solid masses with less MI and weaker Doppler flow, distinct from metastatic cancer's bilateral solid masses with strong vascularity, providing preoperative discriminative reference [15]. MRI offers superior soft-tissue resolution, with contrast-enhanced scans being preferred for endometrial cancer to precisely assess myometrial/cervical invasion and nodal metastasis [16], critical for fertility-sparing or inoperable cases. Contrast-enhanced CT serves as the standard for primary ovarian cancer evaluation (tumors/ascites/peritoneal metastases), guiding surgery or neoadjuvant chemotherapy[17], and is first-line for postoperative surveillance, supplemented by PET-CT/MRI for micro-metastasis detection. Preoperative imaging was reviewed for all 48 SEOC patients. Abnormalities were detected in 95.8% of cases. These results underscore the significant value of preoperative imaging in SEOC assessment. Enhanced CT and MRI provide complementary information; combined with serum tumor markers, they offer crucial guidance for surgical decision-making. 4.3 Pathological characteristics and Diagnosis of SEOC Previous studies indicate that SEOC typically presents with early-stage, low-grade endometrioid carcinoma in both sites. Concordant endometrioid histology was observed in 44.2–86% of cases, bilateral grade 1 tumors in 19.6–51%, and bilateral FIGO stage I disease in 17.3–48.1% [5, 6, 14, 18, 19]. In the present cohort of 48 patients, 38 (79.2%) exhibited concordant endometrioid histology, 23 (47.9%) had bilateral grade 1 tumors, and 24 (50.0%) presented with bilateral FIGO stage I disease. These variations across studies may be attributable to differences in sample sizes. Combining preoperative serum tumor markers, imaging, D&C, and intraoperative frozen section analysis readily confirms malignancy in both endometrial and ovarian lesions. However, distinguishing synchronous primary carcinomas from metastatic disease, particularly when histology is concordant, remains challenging. In 1985, Ulbright and Roth [20] first proposed pathological criteria to distinguish metastatic carcinoma from synchronous primary carcinomas. The major diagnostic criterion for metastatic disease was multinodular ovarian involvement; minor criteria included small ovarian size (< 5 cm), bilateral involvement, deep myometrial invasion, LVSI, and fallopian tube lumen involvement. In 1998, Scully et al. [10] modified these criteria to establish the histopathological diagnostic standards for SEOC and summarized features distinguishing primary endometrial cancer with ovarian metastasis from primary ovarian cancer with endometrial metastasis (detailed in Table 1). These criteria have been widely applied in clinical practice. Concurrently, studies have also explored ancillary techniques to aid SEOC diagnosis and differentiation, including X-chromosome inactivation patterns, mutation analysis (e.g., TP53 , KRAS , PTEN , PIK3CA , POLE , CTNNB1 ), immunohistochemistry (IHC), vimentin expression, loss of heterozygosity (LOH), and microsatellite instability (MSI) [21–26]. These investigations highlighted the limitations of purely histopathological criteria and demonstrated the potential utility of molecular testing [26, 27]. In this study, only 17 of the 48 SEOC patients underwent IHC on both endometrial and ovarian tumor tissues. Among these, 8 patients exhibited concordant MMRd in both sites, suggesting an association with Lynch syndrome (only 1 had a first-degree relative with malignancy). Five of these 8 patients had endometrioid histology in both carcinomas. Molecular testing was performed in only 2 patients: one showed no microsatellite instability (MSI), and molecular classification in the other identified a POLE ultramutated endometrial carcinoma. With the advent of next-generation sequencing (NGS), studies suggest that the majority of SEOC cases demonstrate molecular clonality, indicating metastatic spread rather than independent primaries, although the origin and direction of spread remain undetermined [28, 29]. However, socioeconomic constraints limit the widespread adoption of molecular testing. Consequently, distinguishing true independent primaries from metastases remains challenging, and a growing body of research supports classifying SEOC primarily as endometrial carcinoma with ovarian metastasis [30, 31]. Nonetheless, current evidence suggests SEOC confined to the endometrium and ovaries, characterized by low-grade endometrioid histology, carries a favorable prognosis compared to endometrial carcinoma with ovarian metastasis. Reflecting this, the updated 2023 FIGO endometrial cancer staging classifies such SEOC cases as stage IA3. For IA3 disease meeting specific criteria (myometrial invasion < 50%, no extensive LVSI, unilateral ovarian involvement without capsule rupture), no adjuvant therapy is recommended post-surgery. Conversely, endometrial carcinomas with aggressive histology (e.g., G3 endometrioid, serous, clear cell, carcinosarcoma) confined to an endometrial polyp or the endometrium itself are now classified as stage IC, with molecular classification recommended for all patients to guide staging and treatment [32]. This implies SEOC cases with aggressive endometrial histology should be classified as endometrial carcinoma with adnexal metastasis. This new classification diverges from the traditional Scully criteria [10], which did not incorporate tumor aggressiveness, molecular profiling, prognosis, or management considerations. While the IA3 category specifically identifies a prognostically favorable SEOC subset, its impact on survival and clinical management requires substantial validation. Notably, the latest NCCN Guidelines (2025) for endometrial cancer have not yet adopted this staging for surgical or adjuvant therapy decisions. 4.4. Treatment and Prognosis of SEOC 4.4. 1 Treatment Due to the predominance of small-sample, retrospective studies and the inherent difficulty in preoperative diagnosis, standardized guidelines for SEOC management remain lacking. Although radical surgery (hysterectomy-BSO, lymphadenectomy, omentectomy) is recommended [5], our cohort demonstrates critical staging gaps: 35.4% (17/48) underwent initial surgery based on D&C-confirmed endometrial cancer, while 8.3% (4/48) required completion surgery after emergency operations for ovarian pathology. Intraoperative frozen section detected ovarian carcinoma in 89.6% (43/48), yet only 54.2% (26/48) achieved complete staging due to technical constraints (e.g., adhesions preventing lymphadenectomy in 12.5%). These findings underscore the urgent need for individualized surgical protocols. Postoperative adjuvant therapy of SEOC remains contentious. Misdiagnosing SEOC as either stage III endometrial cancer or stage II ovarian cancer may prompt overtreatment. However, recent studies suggest that identifying risk factors in SEOC may be more crucial for treatment decisions than precisely differentiating it from metastatic disease [33]. Most studies suggest early-stage, low-grade, endometrioid histology confined to the uterus and ovaries may not require adjuvant therapy [9], whereas advanced-stage, high-grade disease, or residual tumor warrants aggressive adjuvant therapy [34]. Within the low-risk cohort (14/48, 29.2%), the single untreated patient developed radiologically confirmed nodal recurrence (mediastinal/hilar lymphadenopathy via PET-CT) at 5 postoperative months, whereas all 13 chemotherapy-treated counterparts remained disease-free. Conversely, 4 of 34 high-risk patients (70.8%) maintained recurrence-free survival without adjuvant therapy. The high adjuvant therapy rate (92.9%) in the low-risk group likely reflects diagnostic uncertainty (e.g., misdiagnosis as metastatic ovarian cancer) and the lack of standardized management for this rare disease. These findings necessitate multicenter validation to determine survival benefit of adjuvant therapy in low-risk SEOC. 4.4.2 Prognosis SEOC demonstrates superior 5-year overall survival 89.1% in our cohort, aligning with 83-85.9% literature reported[19, 35]. In contrast, stage III endometrial cancer has a 5-year OS of 57%-66% [36], while stage II endometrioid ovarian cancer is approximately 82% [37]. Research on prognostic factors for SEOC remains limited. Advances in molecular testing offer insights into SEOC pathogenesis and origin, with significant implications for clinical management and prognosis. A 2020 Dutch multicenter retrospective study [30] compared SEOC molecular profiles with TCGA data, revealing higher frequencies of PTEN and CTNNB1 mutations but fewer TP53 mutations compared to metastatic tumors. Critically, TP53 mutation independently predicts poor prognosis, establishing molecular profiling (particularly TP53 status) as essential for risk stratification and adjuvant therapy guidance. While 17 patients in our study underwent IHC (8 suggesting possible Lynch syndrome), molecular confirmation of Lynch association was not performed. Nevertheless, Lynch syndrome screening may be warranted for young patients desiring fertility preservation. Limited studies identify age, menopausal status, preoperative CA-125, LVSI, cervical stromal invasion, histology, tumor grade, ovarian cancer stage, and residual tumor as potential prognostic factors [6, 9, 14, 18, 19, 33, 38].Our analysis revealed a significantly worse 5-year OS in patients with non-endometrioid histology in either site (p = 0.016), consistent with prior studies [11, 14, 26]. Non-endometrioid ovarian carcinoma histology (p = 0.008) and non-stage I ovarian cancer (p = 0.032) were also associated with poorer survival, corroborating Caldarella et al. [18], likely reflecting the aggressive nature of ovarian cancer. This underscores the importance of ovarian tumor pathology and FIGO stage in guiding SEOC management. Preoperative CA-125, LVSI, cervical stromal invasion, and menopausal status showed no significant association with survival in our cohort. The prognostic impact of lymph node metastasis (LNM) in SEOC remains controversial. Turashvili et al. [33] reported that LNM was an independent predictor of worse PFS (HR = 2.38, 95% CI 1.13–5.02, p = 0.023) in their 2019 multivariate analysis. Conversely, Bese et al. [38] found no significant association between LNM and survival outcomes. Our study demonstrated significantly reduced 5-year OS and PFS in SEOC patients with LNM (p < 0.001). While LNM upstages both endometrial and ovarian cancers in advanced disease, the therapeutic benefit of systematic lymphadenectomy is debated [39, 40]. Given that SEOC typically presents early-stage, low-grade endometrioid carcinoma with favorable prognosis, systematic lymphadenectomy may be unnecessary. This procedure increases operative time, perioperative complications (e.g., transfusion, infection), and long-term risks like lymphocyst formation. Preoperative imaging assessment and intraoperative lymphatic mapping offer alternatives to mitigate these risks. Limitations of this single-center retrospective study include its small sample size and the underrepresentation of aggressive histology (only one non-endometrioid endometrial carcinoma case), potentially limiting the identification of additional prognostic factors. Multivariate analysis in this study did not identify independent prognostic factors for SEOC survival. This is likely attributable to the rarity of the disease and the limited sample size. Future studies with larger cohorts are warranted to elucidate prognostic factors and guide adjuvant therapy decisions. Additionally, the value of preoperative imaging and tumor markers in diagnosis merits further investigation to inform surgical planning. 5. Conclusion In summary, compared to single-site endometrial or ovarian cancer, synchronous endometrial and ovarian carcinomas (SEOC) predominantly affect younger, premenopausal women. Abnormal vaginal bleeding is the most common initial symptom. SEOC typically exhibits early-stage, low-grade, endometrioid histology in both sites (EEC/EOC). Preoperative diagnosis is challenging due to non-specific clinical manifestations. Imaging studies, particularly when combined with serum tumor markers, provide crucial guidance for surgical planning. Patients with low-grade endometrioid carcinoma in both sites generally have a favorable prognosis. Ovarian tumor histology and FIGO stage significantly influence survival and guide adjuvant therapy decisions. While LNM is a poor prognostic factor, the benefit of systematic lymphadenectomy in early-stage SEOC requires further investigation. Abbreviations BMI Body Mass Index EC Endometrial Carcinoma EEC Endometrioid Endometrial Cancer EOC Endometrioid Ovarian Cancer FIGO Federation of International of Gynecology and Obstetrics GOG Gynecologic Oncology Group IHC Immunohistochemistry LVSI Lymph Vascular Space Invasion MI Myometrial Invasion MMR Mismatch Repair MSI Microsatellite Instability OC Ovarian Carcinoma OS Overall Survival PFS Progression-Free Survival PORTEC Post-Operative Radiation Therapy in Endometrial Cancer SEOC NCCN Synchronous Endometrial and Ovarian Carcinoma National Comprehensive Cancer Network Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Institutional Ethics Committee of West China Second University Hospital, Sichuan University (Approval No: 2023-140). Written informed consent was obtained from all individual participants included in the study. Consent for publication Not applicable. Availability of data and materials The data supporting the findings of this study are not openly available due to sensitivity reasons. However, they are available from the author upon reasonable request. Competing interests The authors declare no potential conflicts of interest. Funding Not applicable. Author information Department of Gynecology and Obstetrics, Affiliated Hospital of Sichuan Nursing Vocational College (The Third People's Hospital of Sichuan Province), Chengdu, Sichuan, China Wenli Gan Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China Ce Bian Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China Jitong Zhao Author contributions GWL : Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing – original draft, Writing – review & editing. BC ： Conceptualization, Formal analysis, Methodology, Validation, Resources, Visualization, Supervision. ZJT : Formal analysis, Validation, Resources, Visualization, Writing – review & editing. All authors read and approved of the final manuscript. Corresponding author Correspondence to Wenli Gan. Acknowledgment We extend our sincere gratitude to all the patients who participated in this study. The authors declare no potential conflicts of interest. References Eisner RF, Nieberg RK, Berek JS: Synchronous primary neoplasms of the female reproductive tract . Gynecol Oncol 1989, 33 (3):335-339. Ayhan A, Yalcin OT, Tuncer ZS, Gurgan T, Kucukali T: Synchronous primary malignancies of the female genital tract . Eur J Obstet Gynecol Reprod Biol 1992, 45 (1):63-66. Tong SY, Lee YS, Park JS, Bae SN, Lee JM, Namkoong SE: Clinical analysis of synchronous primary neoplasms of the female reproductive tract . 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Kobayashi Y, Nakamura K, Nomura H, Banno K, Irie H, Adachi M, Iida M, Umene K, Nogami Y, Masuda K et al : Clinicopathologic analysis with immunohistochemistry for DNA mismatch repair protein expression in synchronous primary endometrial and ovarian cancers . Int J Gynecol Cancer 2015, 25 (3):440-446. Singh N: Synchronous tumours of the female genital tract . Histopathology 2010, 56 (3):277-285. Jain V, Sekhon R, Pasricha S, Giri S, Modi KB, Shrestha E, Ram D, Rawal S: Clinicopathological Characteristics and Prognostic Factors of Synchronous Endometrial and Ovarian Cancers-A Single-Institute Review of 43 Cases . Int J Gynecol Cancer 2017, 27 (5):938-946. Moro F, Leombroni M, Pasciuto T, Trivellizzi IN, Mascilini F, Ciccarone F, Zannoni GF, Fanfani F, Scambia G, Testa AC: Synchronous primary cancers of endometrium and ovary vs endometrial cancer with ovarian metastasis: an observational study . Ultrasound in Obstetrics & Gynecology 2019, 53 (6):827-835. Maheshwari E, Nougaret S, Stein EB, Rauch GM, Hwang K-P, Stafford RJ, Klopp AH, Soliman PT, Maturen KE, Rockall AG et al : Update on MRI in Evaluation and Treatment of Endometrial Cancer . RadioGraphics 2022, 42 (7):2112-2130. Kang SK, Reinhold C, Atri M, Benson CB, Bhosale PR, Jhingran A, Lakhman Y, Maturen KE, Nicola R, Pandharipande PV et al : ACR Appropriateness Criteria ® Staging and Follow-Up of Ovarian Cancer . Journal of the American College of Radiology 2018, 15 (5):S198-S207. Caldarella A, Crocetti E, Taddei GL, Paci E: Coexisting endometrial and ovarian carcinomas: a retrospective clinicopathological study . Pathol Res Pract 2008, 204 (9):643-648. Zaino R, Whitney C, Brady MF, DeGeest K, Burger RA, Buller RE: Simultaneously detected endometrial and ovarian carcinomas--a prospective clinicopathologic study of 74 cases: a gynecologic oncology group study . Gynecol Oncol 2001, 83 (2):355-362. Ulbright TM, Roth LM: Metastatic and independent cancers of the endometrium and ovary: a clinicopathologic study of 34 cases . Hum Pathol 1985, 16 (1):28-34. Fujita M, Enomoto T, Wada H, Inoue M, Okudaira Y, Shroyer KR: Application of clonal analysis. Differential diagnosis for synchronous primary ovarian and endometrial cancers and metastatic cancer . Am J Clin Pathol 1996, 105 (3):350-359. Halperin R, Zehavi S, Hadas E, Habler L, Bukovsky I, Schneider D: Simultaneous carcinoma of the endometrium and ovary vs endometrial carcinoma with ovarian metastases: a clinical and immunohistochemical determination . Int J Gynecol Cancer 2003, 13 (1):32-37. Ikeda Y, Oda K, Nakagawa S, Murayama-Hosokawa S, Yamamoto S, Ishikawa S, Wang L, Takazawa Y, Maeda D, Wada-Hiraike O et al : Genome-wide single nucleotide polymorphism arrays as a diagnostic tool in patients with synchronous endometrial and ovarian cancer . Int J Gynecol Cancer 2012, 22 (5):725-731. Desouki MM, Kallas SJ, Khabele D, Crispens MA, Hameed O, Fadare O: Differential vimentin expression in ovarian and uterine corpus endometrioid adenocarcinomas: diagnostic utility in distinguishing double primaries from metastatic tumors . Int J Gynecol Pathol 2014, 33 (3):274-281. Ishikawa M, Nakayama K, Nakamura K, Ono R, Yamashita H, Ishibashi T, Minamoto T, Iida K, Razia S, Ishikawa N et al : High frequency of POLE mutations in synchronous endometrial and ovarian carcinoma . Hum Pathol 2019, 85 :92-100. Ramus SJ, Elmasry K, Luo Z, Gammerman A, Lu K, Ayhan A, Singh N, McCluggage WG, Jacobs IJ, Whittaker JC et al : Predicting clinical outcome in patients diagnosed with synchronous ovarian and endometrial cancer . Clin Cancer Res 2008, 14 (18):5840-5848. Monzon FA: A Molecular Genetic and Statistical Approach for the Diagnosis of Dual-Site Cancers . Yearbook of Pathology and Laboratory Medicine 2006, 2006 :243-244. Anglesio MS, Wang YK, Maassen M, Horlings HM, Bashashati A, Senz J, Mackenzie R, Grewal DS, Li-Chang H, Karnezis AN et al : Synchronous Endometrial and Ovarian Carcinomas: Evidence of Clonality . J Natl Cancer Inst 2016, 108 (6):djv428. Schultheis AM, Ng CK, De Filippo MR, Piscuoglio S, Macedo GS, Gatius S, Perez Mies B, Soslow RA, Lim RS, Viale A et al : Massively Parallel Sequencing-Based Clonality Analysis of Synchronous Endometrioid Endometrial and Ovarian Carcinomas . J Natl Cancer Inst 2016, 108 (6):djv427. Iacobelli V, Zannoni GF, Gui B, Fagotti A, Scambia G, Fanfani F: Molecular and biological profile may discriminate between synchronous or metachronous endometrial and ovarian cancer . Int J Gynecol Cancer 2020, 30 (7):1071-1076. Moukarzel LA, Da Cruz Paula A, Ferrando L, Hoang T, Sebastiao APM, Pareja F, Park KJ, Jungbluth AA, Capella G, Pineda M et al : Clonal relationship and directionality of progression of synchronous endometrial and ovarian carcinomas in patients with DNA mismatch repair-deficiency associated syndromes . Mod Pathol 2021, 34 (5):994-1007. McCluggage WG, Bosse T, Gilks CB, Howitt BE, McAlpine JN, Nucci MR, Rabban JT, Singh N, Talia KL, Parra-Herran C: FIGO 2023 endometrial cancer staging: too much, too soon? International Journal of Gynecological Cancer 2024, 34 (1):138-143. Turashvili G, Gomez-Hidalgo NR, Flynn J, Gonen M, Leitao MM, Jr., Soslow RA, Murali R: Risk-based stratification of carcinomas concurrently involving the endometrium and ovary . Gynecol Oncol 2019, 152 (1):38-45. Wang T, Zhang X, Lu Z, Wang J, Hua K: Comparison and analysis of the clinicopathological features of SCEO and ECOM . J Ovarian Res 2019, 12 (1):10. Signorelli M, Fruscio R, Lissoni AA, Pirovano C, Perego P, Mangioni C: Synchronous early-stage endometrial and ovarian cancer . Int J Gynaecol Obstet 2008, 102 (1):34-38. Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E: Endometrial cancer . Lancet 2016, 387 (10023):1094-1108. Torre LA, Trabert B, DeSantis CE, Miller KD, Samimi G, Runowicz CD, Gaudet MM, Jemal A, Siegel RL: Ovarian cancer statistics, 2018 . CA Cancer J Clin 2018, 68 (4):284-296. Bese T, Sal V, Kahramanoglu I, Tokgozoglu N, Demirkiran F, Turan H, Ilvan S, Arvas M: Synchronous Primary Cancers of the Endometrium and Ovary With the Same Histopathologic Type Versus Endometrial Cancer With Ovarian Metastasis: A Single Institution Review of 72 Cases . Int J Gynecol Cancer 2016, 26 (2):394-406. Kuroki L, Guntupalli SR: Treatment of epithelial ovarian cancer . Bmj 2020. Makker V, MacKay H, Ray-Coquard I, Levine DA, Westin SN, Aoki D, Oaknin A: Endometrial cancer . Nat Rev Dis Primers 2021, 7 (1):88. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8116283","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590168492,"identity":"fda178ee-4531-4aba-9e9a-64e79bdcbfb6","order_by":0,"name":"Wenli Gan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACxvmHDz74+Oe/HRt7A5FamGewJRvObGBO5uM5QKQW9hk8ZtK8DcyM8yQSiNTCO7vH2Jh3Bxszm+TjjTcYamyiCWqRnHOs8OHcMzx8bNJpxRYMx9JyGwhpMWxI3mzwhk2CmU06x0yCseEwYS32BxLMJHjYDBjbJM8QqYVxRoqZJG9bAmObBA+xWnqOJRvOOHMgmY0H6JcEYvzC2N588MGHigN28u2HN974UGNDWAsyMCA6apC0kKpjFIyCUTAKRgYAAHytP3RDb625AAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Hospital of Sichuan Nursing Vocational College (The Third People's Hospital of Sichuan Province)","correspondingAuthor":true,"prefix":"","firstName":"Wenli","middleName":"","lastName":"Gan","suffix":""},{"id":590168493,"identity":"f89df6f8-c62b-424c-8110-a4704bf88cb7","order_by":1,"name":"Ce Bian","email":"","orcid":"","institution":"West China Second University Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Ce","middleName":"","lastName":"Bian","suffix":""},{"id":590168494,"identity":"26c1ddec-76d5-40f7-b3b6-43e35359ae04","order_by":2,"name":"Jitong Zhao","email":"","orcid":"","institution":"West China Second University Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Jitong","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2025-11-14 15:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8116283/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8116283/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102806830,"identity":"b46fce45-fe42-4e56-8be2-0ab52d3cbad3","added_by":"auto","created_at":"2026-02-17 00:53:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":547673,"visible":true,"origin":"","legend":"\u003cp\u003eThe microscopic pathological characteristics of SEOC: A: G1/ G2-3, EEC/EOC（HE×100） B. G1/G1,EEC/MOC（HE×100）C. a. G1/G3, EEC/SOC（HE×100）D. G3/G1, Mixed/EOC（HE×40）E. G2/G3, EEC/CC（HE×100）.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8116283/v1/715650245c1c5158389209bf.png"},{"id":102806829,"identity":"210f36ba-f5a2-4b34-9f90-499a120467b1","added_by":"auto","created_at":"2026-02-17 00:53:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":113651,"visible":true,"origin":"","legend":"\u003cp\u003eA.The influence of different factors on OS: a. The OC histotype; b. The SEOC histotype; c. The SEOC grade; d. The OC stage; e. The lymphatic metastasis; f. The lymph node dissection. B. The influence of different factors on PFS: a. The OC histotype; b. The lymphatic metastasis.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8116283/v1/d09319e594ba777aa43c45ec.png"},{"id":103398019,"identity":"05cc222a-7341-43a7-89b0-53bc7c4a8918","added_by":"auto","created_at":"2026-02-25 08:58:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3684140,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8116283/v1/b6ef88d7-c1c0-47fe-8b58-859ab04d47ce.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinicopathological features and prognosis of synchronous endometrial and ovarian carcinoma","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSynchronous primary carcinomas of the female reproductive system are rare, accounting for 0.63% to 1.7% of all gynecologic malignancies. Among these, synchronous endometrial and ovarian carcinoma (SEOC) is the most frequent subtype, representing 40%\u0026ndash;51.7% of cases[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. SEOC occurs in less than 3% of ovarian cancer patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and 3.8%\u0026ndash;5.5% of endometrial cancer cohorts [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Due to nonspecific clinical presentations, most SEOC cases are diagnosed postoperatively through pathological examination, though diagnostic criteria remain controversial.\u003c/p\u003e \u003cp\u003e Current evidence on SEOC is limited, and standardized global management guidelines are lacking. Radical surgery constitutes the primary treatment, involving comprehensive surgical staging (hysterectomy, bilateral salpingo-oophorectomy, pelvic/para-aortic lymphadenectomy, and omentectomy) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Studies suggest favorable overall survival, particularly for tumors confined to the uterus and ovaries, which exhibit low recurrence and metastasis rates and may not require adjuvant therapy[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the absence of preoperative diagnostic specificity and challenges in pathological differentiation often lead to misclassification as Stage III endometrial or Stage II ovarian cancer. This may result in overtreatment with unnecessary adjuvant chemoradiation. Therefore, establishing evidence-based diagnostic and therapeutic guidelines through rigorous research is imperative to optimize patient outcomes. This study analyzes clinicopathological characteristics and prognostic factors in 48 SEOC patients to inform personalized management strategies.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Materials\u003c/h2\u003e \u003cp\u003e Approved by the Ethics Committee of West China Second University Hospital (No. 2023\u0026thinsp;\u0026minus;\u0026thinsp;140), this retrospective study analyzed 48 SEOC cases with complete clinicopathological and follow-up data treated between January 2015 and December 2022. The inclusion criteria included: (1) age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (2) histopathological confirmation of synchronous primary endometrial and ovarian carcinomas according to Scully's diagnostic criteria[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]; (3) availability of complete clinicopathological data and reliable follow-up. Exclusion criteria comprised: (1) incomplete medical records or unreliable follow-up; (2) non-epithelial malignancies (borderline ovarian tumors, sex cord-stromal tumors, mesenchymal tumors, mixed epithelial-stromal tumors, Brenner tumors, uterine sarcomas, or carcinosarcomas); (3) primary/secondary surgeries were performed outside our institution.\u003c/p\u003e \u003cp\u003eComprehensive clinicopathological parameters were extracted from medical records, including: patient demographics (age, BMI, reproductive history, menopausal status, family history, comorbidities); preoperative assessments (imaging: ultrasound/CT/MRI; tumor markers: CA125/CA19-9); surgical details (approach, intraoperative findings, residual tumor status); adjuvant therapy (chemotherapy regimens/cycles); oncologic outcomes (recurrence timing/location, survival data); and pathological characteristics (histologic type, grade, FIGO stage, tumor dimensions, lymph node metastasis, lymphovascular space invasion (LVSI), depth of myometrial invasion (MI), cervical stromal involvement, presence of endometrial atypical hyperplasia or ovarian endometriosis, and immunohistochemistry (p53, ER, PR, MMRd).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Diagnosis\u003c/h2\u003e \u003cp\u003eAll histopathological slides underwent centralized review by at least two pathologists. SEOC diagnosis was confirmed using Scully's criteria [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), integrating clinical history and auxiliary examinations. Patients were stratified into low-risk and high-risk groups based on histologic type, differentiation, and FIGO stage. Low-risk group: Patients with dual endometrioid histology, low-grade differentiation (G1), and FIGO Stage I disease at both sites. High-risk group: Patients exhibiting Non-endometrioid histology, high-grade differentiation (Non-G1), or advanced-stage (Non-Stage I) disease at either site.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHistopathological diagnosis and differentiation criteria for concurrent endometrial carcinoma and ovarian cancer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependent Primary Tumors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndometrial Primary\u003c/p\u003e \u003cp\u003eOvarian Secondary\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOvarian Primary\u003c/p\u003e \u003cp\u003eEndometrial Secondary\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.Histologic dissimilarity of the tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.Histologic similarity of the tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Histologic similarity of the tumors\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. No or only superficial myometrial invasion of\u003c/p\u003e \u003cp\u003eendometrial tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2. Large endometrial tumor - small ovarian tumor(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2. Large ovarian tumor - small endometrial tumor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.No vascular space invasion of endometrial tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3. Atypical endometrial hyperplasia additionally\u003c/p\u003e \u003cp\u003epresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3. Ovarian endometriosis present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.Atypical endometrial hyperplasia additionally\u003c/p\u003e \u003cp\u003epresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4. Deep myometrial invasion\u003c/p\u003e \u003cp\u003ea. Direct extension into adnexa\u003c/p\u003e \u003cp\u003eb. Vascular space invasion in myometrium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4. Location in ovarian parenchyma\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.Absence of other evidence of the spread of endometrial tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5. Spread elsewhere in typical pattern of endometrial\u003c/p\u003e \u003cp\u003ecarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5. Direct extension from ovary predominantly into\u003c/p\u003e \u003cp\u003eouter wall of uterus\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.Ovarian tumor unilateral (80 to 90 percent of cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6. Ovarian tumors bilateral and/or multinodular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6. Spread elsewhere in the typical pattern of ovarian carcinoma\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.Ovarian tumor located in parenchyma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7. Hilar location, vascular space invasion, surface\u003c/p\u003e \u003cp\u003eimplants, or combination in ovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7. Ovarian tumor unilateral (80 to 90 percent of cases) and forming single mass\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.No vascular space invasion, surface implants, or predominant hilar location in ovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8. Ovarian endometriosis absent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8. No atypical hyperplasia in endometrium\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.Absence of other evidence of spread of ovarian tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9. Aneuploidy with similar DNA indices or diploidy of both tumors*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9. Aneuploidy with similar DNA indices or diploidy of both tumors*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.Ovarian endometriosis present\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10. Similar molecular genetic or karyotypic abnormalities in both tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10. Similar molecular genetic or karyotypic abnormalities in both tumors\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Different ploidy or DNA indices, if aneuploid, of the tumors*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12.Dissimilar molecular genetic or karyotypic\u003c/p\u003e \u003cp\u003eabnormalities in the tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*The possibility of tumor heterogeneity must be considered in the evaluation of the ploidy findings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Staging\u003c/h2\u003e \u003cp\u003eAll 48 patients underwent surgical management. Due to the retrospective nature of this study (2015\u0026ndash;2022) where molecular profiling was not routinely performed, endometrial cancer staging followed the 2009 FIGO criteria and ovarian cancer staging adhered to the 2014 FIGO system. SEOC stage I was strictly defined as FIGO stage I disease in both endometrial and ovarian lesions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Treatment\u003c/h2\u003e \u003cp\u003eAll 48 SEOC patients underwent radical surgery, comprising total hysterectomy, bilateral salpingo-oophorectomy, with or without omentectomy, with or without pelvic lymphadenectomy, with or without para-aortic lymph node sampling/dissection, with or without appendectomy. Given the rarity of this malignancy and limited literature, adjuvant treatment plans were formulated through multidisciplinary tumor board discussions based on intraoperative findings and final pathology, incorporating patient-centered shared decision-making.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Follow-up\u003c/h2\u003e \u003cp\u003ePatient follow-up was conducted through outpatient clinic reviews and telephone interviews. The survival period was calculated in months, with the surgery date as the starting point and December 31, 2024, as the cutoff date. Progression-free survival (PFS) was defined as time from surgery to disease recurrence, metastasis, or death. Cases without events were censored at the last follow-up. Overall survival (OS) was defined as time from surgery to all-cause death. Surviving patients were censored at the last follow-up. Follow-up was conducted once every 3 months for the first 2 years postoperatively, once every 6 months during years 3\u0026ndash;5, and annually thereafter. The follow-up assessments include Pelvic examination, serum tumor markers (CA125, CA199), and imaging (CT, vaginal color Doppler ultrasound).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Statistical method\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics 27. Continuous variables are presented as median (range); categorical variables as frequency (%). Kaplan-Meier curves with log-rank tests compared to survival between subgroups. Variables with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were entered into multivariate Cox proportional hazards regression. \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 The basic clinical characteristics of SEOC\u003c/h2\u003e\n \u003cp\u003eWe identified 48 patients who were diagnosed with SEOC by surgery and histopathology. The median age at diagnosis was 47 years (range: 27\u0026ndash;59), with median BMI 23.2 kg/m\u0026sup2; (range: 16.4\u0026ndash;35.2). 3 patients (6.3%) were obese (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u0026sup2;), 12 (25.0%) were nulliparous, and 42 (87.5%) were premenopausal. Vaginal bleeding was the most common presenting symptom (22 abnormal uterine bleeding and 4 postmenopausal bleeding. Preoperative imaging revealed: 13 patients (27.1%) with both ovarian and endometrial lesions, 28 (58.3%) with isolated ovarian lesions, 5 (10.4%) with isolated endometrial lesions, and 2 (4.2%) without detectable lesions. The median preoperative CA125 levels were 276.1 U/mL (range: 5.2\u0026ndash;4146.6 U/mL), elevated (\u0026gt;\u0026thinsp;35 U/mL) in 39 patients (81.3%). The median preoperative CA199 levels were 237.5U/mL (range 5.3\u0026ndash;36,539.1 U/mL), elevated (\u0026gt;\u0026thinsp;34.1 U/mL) in 37 patients (77.1%). The patients\u0026apos; baseline characteristics are detailed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cstrong\u003eclinicopathologic feature\u003c/strong\u003es \u003cstrong\u003eof patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eclinicopathologic\u0026nbsp;features\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;45y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;45y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.5-24.9kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25-29.9 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;30kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMenopausal state\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostmenopausal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePremenopausal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInitial symptom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVaginal bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdominal pain /bloating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo clinical symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative imaging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOvary (+) Endometrium (-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOvary (-) Endometrium (+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOvary (+) Endometrium (+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOvary (-) Endometrium (-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCA125 U/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCA 199 U/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative D\u0026amp;C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymph node dissection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCytology of ascites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymph node metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;1/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;1/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCervical stromal invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLVSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtypical endometrial hyperplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOvarian endometriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdjuvant therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy\u0026thinsp;+\u0026thinsp;Radiation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometrial histological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometrioid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMixed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometrial histological grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometrial FIGO stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅣ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOvarian histological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometrioid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMucinous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClear cell\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMixed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOvarian histological grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOvarian FIGO stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅣ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eBMI: Body Mass Index, underweight: \u0026lt;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e, normal༚18.5-24.9kg/m\u003csup\u003e2\u003c/sup\u003e, overweight༚25-29.9 kg/m\u003csup\u003e2\u003c/sup\u003e, obese༚\u0026ge;30kg/m\u003csup\u003e2\u003c/sup\u003e. D\u0026amp;C: Dilation and Curettage. MI: Myometrial invasion. LVSI: Lymph Vascular Space Invasion. FIGO: Federation of International of Gynecology and Obstetrics.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Pathological characteristics of SEOC\u003c/h2\u003e\n \u003cp\u003eThe pathological features of endometrial cancer are detailed in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e: Histopathology revealed endometrioid carcinoma in 47 cases (97.9%) and mixed adenocarcinoma in 1 case (2.1%, comprising 60% high-grade serous, 30% clear cell, and 10% grade 1 endometrioid components). Tumor grading distribution: 33 G1 (68.8%), 13 G2 (27.1%), 2 G3 (4.2%). FIGO staging: Stage I (81.3%: 38 IA\u0026thinsp;+\u0026thinsp;1 IB), Stage II (8.3%), Stage IIIA (8.3%), Stage IVB (2.1%). Myometrial invasion depth: \u0026ge;1/2 in 3 cases (6.2%), \u0026lt;\u0026thinsp;1/2 in 36 (75%), absent in 9 (18.8%). Cervical stromal invasion was present in 6 patients (12.5%) and LVSI in 7 (14.6%). Concurrent endometrial atypical hyperplasia was identified in 21 cases (43.8%).\u003c/p\u003e\n \u003cp\u003eThe pathological features of ovarian cancer are detailed in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e: Histopathology revealed predominantly endometrioid carcinoma (81.2%, 39/48), with other subtypes including serous (4.2%, 2/48), mucinous (2.1%, 1/48), clear cell (4.2%, 2/48), and mixed adenocarcinomas (8.3%, 4/48: 2 seromucinous, 1 endometrioid-mucinous, 1 clear cell-endometrioid). Tumor grading distribution showed G1 in 58.3% (28/48), G2 in 25% (12/48), and G3 in 16.7% (8/48). FIGO staging comprised Stage I (62.5%: 18 IA, 2 IB, 11 IC), Stage II (27.1%: 2 IIA, 9 IIB, 1 IIC), Stage III (8.3%: 3 IIIA, 1 IIIB), and Stage IVB (2.1%, 1/48). Concurrent ovarian endometriosis was identified in 37.5% (18/48) of cases.\u003c/p\u003e\n \u003cp\u003eThe pathological features of SEOC are detailed in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e: Dual endometrioid histology was observed in 79.2% (38/48) of patients, with 47.9% (23/48) having G1 tumors at both sites, and 50% (24/48) had Stage I tumors synchronously at both sites. The microscopic pathological features of SEOC are shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eHistopathological types of SEOC\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eHistological type of EC\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eEndometrioid\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMixed\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eHistological type of OC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometrioid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMucinous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClear cell\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMixed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003eEC: Endometrial cancer, OC: Ovarian cancer\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3. Treatment\u003c/h2\u003e\n \u003cp\u003eAll 48 patients underwent primary surgery comprising hysterectomy with bilateral salpingo-oophorectomy, plus variable combinations of pelvic/para-aortic lymphadenectomy (87.5%), omentectomy (91.7%), and appendectomy (72.9%). Hysterectomy types included infra-fascial (85.4%), modified radical (12.5%), and subtotal (2.1%, due to renal transplant adhesions). Peritoneal cytology was performed in 75% (18.8% positive). Preoperative endometrial cancer diagnosis was confirmed by D\u0026amp;C in 35.4%, while 8.3% were referred after emergency surgery for ovarian pathology. Adjuvant therapy was determined by multidisciplinary review and shared decision-making: 79.2% (38/48) received platinum-based chemotherapy (paclitaxel-carboplatin/cisplatin, 1\u0026ndash;8 cycles), 10.4% (5/48) chemoradiation, and 10.4% (5/48) no adjuvant therapy.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Survival analysis of SEOC\u003c/h2\u003e\n \u003cp\u003eWith a median follow-up of 59.5 months (cutoff: December 31, 2024), 47 patients (97.9%) completed follow-up. Five deaths and six disease progressions/recurrences occurred. The cohort demonstrated 5-year overall survival of 89.1% and progression-free survival of 87.4%, with mean OS of 108.1 months (95% CI: 99.1-117.1) and mean PFS of 105.8 months (95% CI: 95.9-115.7).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eUnivariate analysis affecting the prognosis of SEOC\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 59.3078%;\"\u003e\n \u003cp\u003efactors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e5-year OS(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.8166%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e5-year PFS(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.647\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;45y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e95.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003e\u0026gt;45y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e84.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e85.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.969\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003e\u0026lt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e92.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e87.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\n \u003cp\u003e0.815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eMultipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e88.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e88.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eMenopausal state\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003ePostmenopausal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003ePremenopausal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e92.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e90.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eInitial symptom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\n \u003cp\u003e0.764\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eVaginal bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e87.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e84.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eCA125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003e\u0026lt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e86.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e84.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eCA 199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\n \u003cp\u003e0.908\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.713\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003e\u0026lt;34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e90.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e90.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e88.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e86.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eAdjuvant therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\n \u003cp\u003e0.422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e87.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e88.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eHistological type of EC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.8166%;\"\u003e\n \u003cp\u003e0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eEEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e47\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e88.9\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 5.7302%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e87.1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eNon-EEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eHistological type of OC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eEOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e94.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e92.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eNon-EOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eHistological type of SEOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eEEC/EOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e94.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e92.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eNon-EEC/EOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eHistological grade of EC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e0.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eG1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e90.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e87.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eNon-G1/G1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e86.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e86.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eHistological grade of OC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eG1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e95.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e92.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eNon-G1/G1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e80.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e80.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eHistological grade of SEOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eG1/G1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e95.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eNon-G1/G1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e79.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e80.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eStage of EC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e0.255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e86.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e84.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eⅡ+Ⅲ+Ⅳ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eStage of OC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e96.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e93.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eⅡ+Ⅲ+Ⅳ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e75.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e77.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eStage of SEOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.425\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e95.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eⅡ+Ⅲ+Ⅳ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e82.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eGroup of SEOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eLow-risk group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e92.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eHigh-risk group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e84.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e85.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003e\u0026lt;1/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e88.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e86.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;1/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eCervical stromal invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.738\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003epositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003enegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e89.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e87.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eLVSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003epositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e68.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003enegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e92.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e90.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eLymph node metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003epositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003enegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e97.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e94.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003emissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eCytology of ascites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e0.482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003epositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e74.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e77.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003enegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e92.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e88.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003emissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eLymph node dissection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e92.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e90.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 19.3395%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 39.825%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 11.747%;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.8874%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6009%;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.8763%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eEC: Endometrial cancer. OC: Ovarian cancer. SEOC: Synchronous endometrial and ovarian carcinoma. EEC/EOC: Endometrioid Endometrial Cancer/Endometrioid Ovarian Cancer. Non-EEC/EOC: The histological type of cancer foci in any part of the endometrium and ovary is non-endometrioid carcinoma. MI: Myometrial Invasion. LVSI: Lymph Vascular Space Invasion. OS: Overall survival. PFS: Progression-free survival. The comparisons among each group were all indicated as statistically significant with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n \u003cp\u003eAs detailed in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, univariate analysis demonstrated significantly reduced 5-year OS in patients with Non-EOC histology (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008), Non-EEC/EOC (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016), Non-G1/G1 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029), Non-Stage I of OC (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032), lymph node metastasis (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), or no lymphadenectomy performed (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029). Concurrently, significantly inferior 5-year PFS was associated specifically with Non-EOC histology (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031) and lymph node metastasis (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007), with all reported associations achieving statistical significance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The Kaplan-Meier curves of OS and PFS affected by different factors are shown in Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eHowever, multivariate Cox regression analysis of variables that showed statistically significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the univariate analysis revealed that none of the associated factors demonstrated independent predictive value for the clinical outcomes of SEOC patients (detailed in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e), with none reaching statistical significance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariate analysis affecting the prognosis of SEOC\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003efactors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5-year OS(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistological type of OC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95557.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u0026thinsp;~\u0026thinsp;1.679E\u0026thinsp;+\u0026thinsp;185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.957\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistological type of SEOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u0026thinsp;~\u0026thinsp;1.088E\u0026thinsp;+\u0026thinsp;174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.944\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistological grade of SEOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11206471.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u0026thinsp;~\u0026thinsp;5.231E\u0026thinsp;+\u0026thinsp;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage of OC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42444.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u0026thinsp;~\u0026thinsp;2.225E\u0026thinsp;+\u0026thinsp;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.509\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymph node metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e316.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u0026thinsp;~\u0026thinsp;7.449E\u0026thinsp;+\u0026thinsp;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymph node dissection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e149643.948\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u0026thinsp;~\u0026thinsp;7.040E\u0026thinsp;+\u0026thinsp;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.458\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5-year PFS(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistological type of OC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.471\u0026thinsp;~\u0026thinsp;20.580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymph node metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.443\u0026thinsp;~\u0026thinsp;24.663\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eOC: Ovarian cancer. SEOC: Synchronous endometrial and ovarian carcinoma. OS: Overall survival. PFS: Progression-free survival.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003e4.1 Clinical characteristics of SEOC\u003c/h2\u003e\n \u003cp\u003eConsistent with prior studies [7, 11, 12], SEOC predominantly affects premenopausal women, with our cohort's median diagnosis age (47 years) aligning with reported ranges (48–50 years) and occurring approximately a decade earlier than single primary endometrial or ovarian cancer [13]. Notably, our data diverged from reported obesity and nulliparity associations [14]: only 25% were nulliparous, and median BMI was 23.2 kg/m² (6.3% obese, BMI ≥ 30 kg/m²). These discrepancies may reflect ethnic, geographic, or sample size variations.\u003c/p\u003e\n \u003cp\u003eConsistent with literatures [5, 11, 12, 14], abnormal vaginal bleeding was the predominant initial symptom (54.2%, 26/48). Although SEOC lacks pathognomonic features, early detection is facilitated by endometrial carcinoma's hallmark symptom—vaginal bleeding—which enabled preoperative histologic diagnosis via Dilation and Curettage \u003cstrong\u003e(\u003c/strong\u003eD\u0026amp;C) in 35.4% of cases, critically informing surgical planning.\u003c/p\u003e\n \u003cp\u003eSerological tumor markers offer referential value; however, preoperative CA125 has limited diagnostic utility for endometrial or ovarian cancer: it may not be elevated in early-stage patients and can be confounded by benign conditions (e.g., infection, endometriosis), being primarily used for treatment monitoring. In this study, 81.3% of SEOC patients exhibited elevated preoperative CA125, aligning with prior conclusions [14], while 77.1% showed CA199 elevation. Their diagnostic performance in SEOC requires further validation with larger sample sizes.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003e4.2 Imaging manifestations of SEOC\u003c/h2\u003e\n \u003cp\u003eCurrent imaging studies on SEOC remain scarce. Routine modalities include ultrasound, CT, and MRI, detecting uterine masses, endometrial thickening, and other abnormalities. Transvaginal ultrasound, being cost-effective, initially evaluates endometrial/adnexal lesions. An Italian study identified SEOC typically as unilateral ovarian multilocular-solid/purely solid masses with less MI and weaker Doppler flow, distinct from metastatic cancer's bilateral solid masses with strong vascularity, providing preoperative discriminative reference [15]. MRI offers superior soft-tissue resolution, with contrast-enhanced scans being preferred for endometrial cancer to precisely assess myometrial/cervical invasion and nodal metastasis [16], critical for fertility-sparing or inoperable cases. Contrast-enhanced CT serves as the standard for primary ovarian cancer evaluation (tumors/ascites/peritoneal metastases), guiding surgery or neoadjuvant chemotherapy[17], and is first-line for postoperative surveillance, supplemented by PET-CT/MRI for micro-metastasis detection. Preoperative imaging was reviewed for all 48 SEOC patients. Abnormalities were detected in 95.8% of cases. These results underscore the significant value of preoperative imaging in SEOC assessment. Enhanced CT and MRI provide complementary information; combined with serum tumor markers, they offer crucial guidance for surgical decision-making.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\"\u003e\n \u003ch2\u003e4.3 Pathological characteristics and Diagnosis of SEOC\u003c/h2\u003e\n \u003cp\u003ePrevious studies indicate that SEOC typically presents with early-stage, low-grade endometrioid carcinoma in both sites. Concordant endometrioid histology was observed in 44.2–86% of cases, bilateral grade 1 tumors in 19.6–51%, and bilateral FIGO stage I disease in 17.3–48.1% [5, 6, 14, 18, 19]. In the present cohort of 48 patients, 38 (79.2%) exhibited concordant endometrioid histology, 23 (47.9%) had bilateral grade 1 tumors, and 24 (50.0%) presented with bilateral FIGO stage I disease. These variations across studies may be attributable to differences in sample sizes.\u003c/p\u003e\n \u003cp\u003eCombining preoperative serum tumor markers, imaging, D\u0026amp;C, and intraoperative frozen section analysis readily confirms malignancy in both endometrial and ovarian lesions. However, distinguishing synchronous primary carcinomas from metastatic disease, particularly when histology is concordant, remains challenging. In 1985, Ulbright and Roth [20] first proposed pathological criteria to distinguish metastatic carcinoma from synchronous primary carcinomas. The major diagnostic criterion for metastatic disease was multinodular ovarian involvement; minor criteria included small ovarian size (\u0026lt; 5 cm), bilateral involvement, deep myometrial invasion, LVSI, and fallopian tube lumen involvement. In 1998, Scully et al. [10] modified these criteria to establish the histopathological diagnostic standards for SEOC and summarized features distinguishing primary endometrial cancer with ovarian metastasis from primary ovarian cancer with endometrial metastasis (detailed in Table\u0026nbsp;1). These criteria have been widely applied in clinical practice. Concurrently, studies have also explored ancillary techniques to aid SEOC diagnosis and differentiation, including X-chromosome inactivation patterns, mutation analysis (e.g., \u003cem\u003eTP53\u003c/em\u003e, \u003cem\u003eKRAS\u003c/em\u003e, \u003cem\u003ePTEN\u003c/em\u003e, \u003cem\u003ePIK3CA\u003c/em\u003e, \u003cem\u003ePOLE\u003c/em\u003e, \u003cem\u003eCTNNB1\u003c/em\u003e), immunohistochemistry (IHC), vimentin expression, loss of heterozygosity (LOH), and microsatellite instability (MSI) [21–26]. These investigations highlighted the limitations of purely histopathological criteria and demonstrated the potential utility of molecular testing [26, 27]. In this study, only 17 of the 48 SEOC patients underwent IHC on both endometrial and ovarian tumor tissues. Among these, 8 patients exhibited concordant MMRd in both sites, suggesting an association with Lynch syndrome (only 1 had a first-degree relative with malignancy). Five of these 8 patients had endometrioid histology in both carcinomas. Molecular testing was performed in only 2 patients: one showed no microsatellite instability (MSI), and molecular classification in the other identified a \u003cem\u003ePOLE\u003c/em\u003e ultramutated endometrial carcinoma. With the advent of next-generation sequencing (NGS), studies suggest that the majority of SEOC cases demonstrate molecular clonality, indicating metastatic spread rather than independent primaries, although the origin and direction of spread remain undetermined [28, 29]. However, socioeconomic constraints limit the widespread adoption of molecular testing. Consequently, distinguishing true independent primaries from metastases remains challenging, and a growing body of research supports classifying SEOC primarily as endometrial carcinoma with ovarian metastasis [30, 31].\u003c/p\u003e\n \u003cp\u003eNonetheless, current evidence suggests SEOC confined to the endometrium and ovaries, characterized by low-grade endometrioid histology, carries a favorable prognosis compared to endometrial carcinoma with ovarian metastasis. Reflecting this, the updated 2023 FIGO endometrial cancer staging classifies such SEOC cases as stage IA3. For IA3 disease meeting specific criteria (myometrial invasion \u0026lt; 50%, no extensive LVSI, unilateral ovarian involvement without capsule rupture), no adjuvant therapy is recommended post-surgery. Conversely, endometrial carcinomas with aggressive histology (e.g., G3 endometrioid, serous, clear cell, carcinosarcoma) confined to an endometrial polyp or the endometrium itself are now classified as stage IC, with molecular classification recommended for all patients to guide staging and treatment [32]. This implies SEOC cases with aggressive endometrial histology should be classified as endometrial carcinoma with adnexal metastasis.\u003c/p\u003e\n \u003cp\u003eThis new classification diverges from the traditional Scully criteria [10], which did not incorporate tumor aggressiveness, molecular profiling, prognosis, or management considerations. While the IA3 category specifically identifies a prognostically favorable SEOC subset, its impact on survival and clinical management requires substantial validation. Notably, the latest NCCN Guidelines (2025) for endometrial cancer have not yet adopted this staging for surgical or adjuvant therapy decisions.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4.4. Treatment and Prognosis of SEOC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4.4. 1 Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDue to the predominance of small-sample, retrospective studies and the inherent difficulty in preoperative diagnosis, standardized guidelines for SEOC management remain lacking. Although radical surgery (hysterectomy-BSO, lymphadenectomy, omentectomy) is recommended [5], our cohort demonstrates critical staging gaps: 35.4% (17/48) underwent initial surgery based on D\u0026amp;C-confirmed endometrial cancer, while 8.3% (4/48) required completion surgery after emergency operations for ovarian pathology. Intraoperative frozen section detected ovarian carcinoma in 89.6% (43/48), yet only 54.2% (26/48) achieved complete staging due to technical constraints (e.g., adhesions preventing lymphadenectomy in 12.5%). These findings underscore the urgent need for individualized surgical protocols.\u003c/p\u003e\n \u003cp\u003ePostoperative adjuvant therapy of SEOC remains contentious. Misdiagnosing SEOC as either stage III endometrial cancer or stage II ovarian cancer may prompt overtreatment. However, recent studies suggest that identifying risk factors in SEOC may be more crucial for treatment decisions than precisely differentiating it from metastatic disease [33]. Most studies suggest early-stage, low-grade, endometrioid histology confined to the uterus and ovaries may not require adjuvant therapy [9], whereas advanced-stage, high-grade disease, or residual tumor warrants aggressive adjuvant therapy [34].\u003c/p\u003e\n \u003cp\u003eWithin the low-risk cohort (14/48, 29.2%), the single untreated patient developed radiologically confirmed nodal recurrence (mediastinal/hilar lymphadenopathy via PET-CT) at 5 postoperative months, whereas all 13 chemotherapy-treated counterparts remained disease-free. Conversely, 4 of 34 high-risk patients (70.8%) maintained recurrence-free survival without adjuvant therapy. The high adjuvant therapy rate (92.9%) in the low-risk group likely reflects diagnostic uncertainty (e.g., misdiagnosis as metastatic ovarian cancer) and the lack of standardized management for this rare disease. These findings necessitate multicenter validation to determine survival benefit of adjuvant therapy in low-risk SEOC.\u003c/p\u003e\n \u003cdiv id=\"Sec18\"\u003e\n \u003ch2\u003e\u003cstrong\u003e4.4.2 Prognosis\u003c/strong\u003e\u003c/h2\u003e\n \u003cp\u003eSEOC demonstrates superior 5-year overall survival 89.1% in our cohort, aligning with 83-85.9% literature reported[19, 35]. In contrast, stage III endometrial cancer has a 5-year OS of 57%-66% [36], while stage II endometrioid ovarian cancer is approximately 82% [37]. Research on prognostic factors for SEOC remains limited. Advances in molecular testing offer insights into SEOC pathogenesis and origin, with significant implications for clinical management and prognosis. A 2020 Dutch multicenter retrospective study [30] compared SEOC molecular profiles with TCGA data, revealing higher frequencies of \u003cem\u003ePTEN\u003c/em\u003e and \u003cem\u003eCTNNB1\u003c/em\u003e mutations but fewer \u003cem\u003eTP53\u003c/em\u003e mutations compared to metastatic tumors. Critically, TP53 mutation independently predicts poor prognosis, establishing molecular profiling (particularly TP53 status) as essential for risk stratification and adjuvant therapy guidance. While 17 patients in our study underwent IHC (8 suggesting possible Lynch syndrome), molecular confirmation of Lynch association was not performed. Nevertheless, Lynch syndrome screening may be warranted for young patients desiring fertility preservation. Limited studies identify age, menopausal status, preoperative CA-125, LVSI, cervical stromal invasion, histology, tumor grade, ovarian cancer stage, and residual tumor as potential prognostic factors [6, 9, 14, 18, 19, 33, 38].Our analysis revealed a significantly worse 5-year OS in patients with non-endometrioid histology in either site (p = 0.016), consistent with prior studies [11, 14, 26]. Non-endometrioid ovarian carcinoma histology (p = 0.008) and non-stage I ovarian cancer (p = 0.032) were also associated with poorer survival, corroborating Caldarella et al. [18], likely reflecting the aggressive nature of ovarian cancer. This underscores the importance of ovarian tumor pathology and FIGO stage in guiding SEOC management. Preoperative CA-125, LVSI, cervical stromal invasion, and menopausal status showed no significant association with survival in our cohort.\u003c/p\u003e\n \u003cp\u003eThe prognostic impact of lymph node metastasis (LNM) in SEOC remains controversial. Turashvili et al. [33] reported that LNM was an independent predictor of worse PFS (HR = 2.38, 95% CI 1.13–5.02, p = 0.023) in their 2019 multivariate analysis. Conversely, Bese et al. [38] found no significant association between LNM and survival outcomes. Our study demonstrated significantly reduced 5-year OS and PFS in SEOC patients with LNM (p \u0026lt; 0.001). While LNM upstages both endometrial and ovarian cancers in advanced disease, the therapeutic benefit of systematic lymphadenectomy is debated [39, 40]. Given that SEOC typically presents early-stage, low-grade endometrioid carcinoma with favorable prognosis, systematic lymphadenectomy may be unnecessary. This procedure increases operative time, perioperative complications (e.g., transfusion, infection), and long-term risks like lymphocyst formation. Preoperative imaging assessment and intraoperative lymphatic mapping offer alternatives to mitigate these risks. Limitations of this single-center retrospective study include its small sample size and the underrepresentation of aggressive histology (only one non-endometrioid endometrial carcinoma case), potentially limiting the identification of additional prognostic factors.\u003c/p\u003e\n \u003cp\u003eMultivariate analysis in this study did not identify independent prognostic factors for SEOC survival. This is likely attributable to the rarity of the disease and the limited sample size. Future studies with larger cohorts are warranted to elucidate prognostic factors and guide adjuvant therapy decisions. Additionally, the value of preoperative imaging and tumor markers in diagnosis merits further investigation to inform surgical planning.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn summary, compared to single-site endometrial or ovarian cancer, synchronous endometrial and ovarian carcinomas (SEOC) predominantly affect younger, premenopausal women. Abnormal vaginal bleeding is the most common initial symptom. SEOC typically exhibits early-stage, low-grade, endometrioid histology in both sites (EEC/EOC). Preoperative diagnosis is challenging due to non-specific clinical manifestations. Imaging studies, particularly when combined with serum tumor markers, provide crucial guidance for surgical planning. Patients with low-grade endometrioid carcinoma in both sites generally have a favorable prognosis. Ovarian tumor histology and FIGO stage significantly influence survival and guide adjuvant therapy decisions. While LNM is a poor prognostic factor, the benefit of systematic lymphadenectomy in early-stage SEOC requires further investigation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"546\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eBody Mass Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eEndometrial Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eEEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eEndometrioid Endometrial Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eEOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eEndometrioid Ovarian Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eFIGO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eFederation of International of Gynecology and Obstetrics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eGOG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eGynecologic Oncology Group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eIHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eImmunohistochemistry\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eLVSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eLymph Vascular Space Invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eMyometrial Invasion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eMMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eMismatch Repair\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eMSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eMicrosatellite Instability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eOvarian Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eOverall Survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003ePFS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eProgression-Free Survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003ePORTEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003ePost-Operative Radiation Therapy in Endometrial Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eSEOC\u003c/p\u003e\n \u003cp\u003eNCCN\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 397px;\"\u003e\n \u003cp\u003eSynchronous Endometrial and Ovarian Carcinoma\u003c/p\u003e\n \u003cp\u003eNational Comprehensive Cancer Network\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Institutional Ethics Committee of West China Second University Hospital, Sichuan University (Approval No: 2023-140). Written informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are not openly available due to sensitivity reasons. However, they are available from the author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Gynecology and Obstetrics, Affiliated Hospital of Sichuan Nursing Vocational College (The Third People's Hospital of Sichuan Province), Chengdu, Sichuan, China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWenli Gan\u003c/p\u003e\n\u003cp\u003eDepartment of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCe Bian\u003c/p\u003e\n\u003cp\u003eDepartment of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJitong Zhao\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eGWL\u003cstrong\u003e:\u003c/strong\u003e Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing – original draft, Writing – review \u0026amp; editing.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eBC\u003cstrong\u003e：\u003c/strong\u003eConceptualization, Formal analysis, Methodology, Validation, Resources, Visualization, Supervision. ZJT\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eFormal analysis, Validation, Resources, Visualization, Writing – review \u0026amp; editing. All authors read and approved of the final manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorresponding author\u003c/p\u003e\n\u003cp\u003eCorrespondence to\u0026nbsp;Wenli Gan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our sincere gratitude to all the patients who participated in this study. The authors declare no potential conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEisner RF, Nieberg RK, Berek JS: \u003cstrong\u003eSynchronous primary neoplasms of the female reproductive tract\u003c/strong\u003e. \u003cem\u003eGynecol Oncol \u003c/em\u003e1989, \u003cstrong\u003e33\u003c/strong\u003e(3):335-339.\u003c/li\u003e\n\u003cli\u003eAyhan A, Yalcin OT, Tuncer ZS, Gurgan T, Kucukali T: \u003cstrong\u003eSynchronous primary malignancies of the female genital tract\u003c/strong\u003e. \u003cem\u003eEur J Obstet Gynecol Reprod Biol \u003c/em\u003e1992, \u003cstrong\u003e45\u003c/strong\u003e(1):63-66.\u003c/li\u003e\n\u003cli\u003eTong SY, Lee YS, Park JS, Bae SN, Lee JM, Namkoong SE: \u003cstrong\u003eClinical analysis of synchronous primary neoplasms of the female reproductive tract\u003c/strong\u003e. \u003cem\u003eEur J Obstet Gynecol Reprod Biol \u003c/em\u003e2008, 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neoplasia, Ovarian neoplasia, Synchronous, Pathological characteristics, Prognostic","lastPublishedDoi":"10.21203/rs.3.rs-8116283/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8116283/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study analyzed clinicopathological characteristics and survival outcomes in 48 patients with synchronous endometrial and ovarian carcinoma (SEOC) treated at West China Second University Hospital (2015\u0026ndash;2022). Kaplan-Meier and log-rank tests compared survival differences; multivariate Cox regression identified independent prognostic factors. Most patients were premenopausal (87.5%) with a median age of 47 years. The median BMI was 23.2 kg/m\u0026sup2; (range: 16.4\u0026ndash;35.2 kg/m\u0026sup2;). The most common presenting symptom was vaginal bleeding. Histopathological analysis revealed that both carcinomas exhibited endometrioid histology in 38 cases (79.2%), were grade 1 in 23 cases (47.9%), and were FIGO stage I in 24 cases (50%). Postoperative adjuvant therapy was administered to 43 patients (89.6%). Survival analysis revealed the following significant prognostic factors: ovarian histologic type (p\u0026thinsp;=\u0026thinsp;0.008), SEOC histologic subtype (p\u0026thinsp;=\u0026thinsp;0.016), SEOC tumor grade (p\u0026thinsp;=\u0026thinsp;0.029), ovarian cancer stage (p\u0026thinsp;=\u0026thinsp;0.032), lymph node metastasis status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and performance of lymphadenectomy (p\u0026thinsp;=\u0026thinsp;0.029). These results shed light on SEOC typically presents with early-stage, low-grade tumors and favorable prognosis. Preoperative imaging and tumor marker assessment provide critical guidance for surgical planning. Lymph node metastasis, ovarian histology and stage critically guide adjuvant therapy. Systematic lymphadenectomy benefits in early-stage disease require further investigation.\u003c/p\u003e","manuscriptTitle":"Clinicopathological features and prognosis of synchronous endometrial and ovarian carcinoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 00:53:00","doi":"10.21203/rs.3.rs-8116283/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"051f3519-a7b1-48ab-ae2a-3877d5a6c2ec","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-25T08:56:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 00:53:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8116283","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8116283","identity":"rs-8116283","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}