Endometrial carcinoma: nontumor factors in prognosis

The clinical records and pathologic specimens from 150 patients with endometrial carcinoma were reviewed to test the hypothesis that constitutionally predisposed patients with evidence of endogenous hyperestrinism (i.e., obesity, hypertension, diabetes, nulliparity, leiomyomata, adenomyosis) have a more benign form of carcinoma than do patients who do not fit this profile. Our results do not support this hypothesis, but do reveal certain other prognostic indicators, in addition to factors relating to the tumor itself, including stage, grade, histologic type, and extent of invasion. These indicators include: (a) age and menopausal status--women over 50 years of age, and more impressively, postmenopausal women of any age, have less favorable histology, staging, and survival; (b) race--black women have higher-grade tumors, higher-stage tumors, and poorer survival rates than white women; (c) hyperplasia--when hyperplasia is found in the biopsy, curettage, or hysterectomy specimen, the accompanying carcinoma is of a much more favorable type and extent, and survival rates are significantly better. The reasons for these correlations are not fully understood, and possible explanations are discussed. There may be two distinct patterns of endometrial carcinoma: a prognostically favorable one arising on a background of hyperplasia predominantly in premenopausal women, and a prognostically unfavorable one, occurring principally in postmenopausal women without hyperplasia. Empirically, we advise pathologists to comment on the presence or absence of hyperplasia in any specimen in which endometrial carcinoma is diagnosed.