An Analysis On The Differences Of Clinicopathological Characteristics And Prognosis Between High-and Low-grade Endometrial Endometrioid Carcinoma

Objectives:To investigate the differences of clinicopathological characteristics and prognosis between high-and low-grade endometrioid endometrial cancer.Methods:Collecting the complete information and data of 913 patients diagnosed of endometrioid endometrial cancer(EEC)and undertaking surgery treatment in the Women's Hospital affiliated to School of Medicine,Zhejiang University from January 2002 to July 2011.Classify the 913 patients into two groups according to the FIGO histological differentiation,name the low grade ones(histological grade I and II)as Group A,and the high grade ones(histological grade III)as Group B.Compare their clinical manifestation,pathological characteristics and prognosis differences.Using chi-square test to analyze the survival time with SPSS 22.0 statistical software,Kaplan-Meier method to calculate survival rate and to draw survival curve,Log-rank method to do difference test of survival rate and Cox model for multivariate analysis.Define p<0.05 as significant difference.Results:1.Uni-variate analysis:the uni-variate analysis shows significant differences in FIGO staging,age of patients when admitted into hospital,menopause or not,the first symptoms(irregular vaginal bleeding and lower abdominal pain),complications of diabetes,tumor behaviors,immuno-histochemistry test,and preoperative E2 level(p<0.05),while menopause age,time from menopause to treating(year),age of menophania,dysmenorrhea or not,complication of hypertension,BMI,preoperative and CA125 level show no significant difference(p>0.05).2.Cox multivariate analysis:Cox multivariate analysis of Group A indicates that age of diagnosis(waldx2=5.007,p=0.025<0.05),FIGO staging(wald?2=5.200,p=0.023<0.05)and deep myometrial invasion(wald?2=5.017,p=0.025<0.05)have significant effect on prognosis of low grade EEC,while age of diagnosis(waldx2=0.078,p=0.018<0.05)and lymphatic metastasis(wald?2=2.433,p=0.000<0.05)have significant effect on the prognosis of high grade EEC.3.Eligible patients(N= 913)included 713 low-grade and 200 high-grade patients;estimated 3-year overall survival(OS)were 97.6%and 91.2%,respectively(p<0.001),and estimated 5-year OS were 96.0%and 84.8%,respectively(p<0.001).Conclusions:1.There are significant differences between high-and low-grade EEC in the clinical manifestation,pathological characteristics and prognosis,suggesting that the two may belong to different tumors with distinct biological behaviors.2.The prognostic factors of low grade and high grade EEC are different.The independent risk factors of low grade EEC includes age of diagnosis,FIGO staging and deep myometrial invasion,while those of high grade EEC are age of diagnosis and lymphatic metastasis.These may help clinician to estimate the prognosis of the two groups according to the above independent risk factors and facilitate institution of personalized treatment algorithms.