UBC Theses and Dissertations
Endometrial carcinoma : description of a novel grading system and identification of additional predictors of patient outcome Alkushi, Abdulmohsen
The aims of our studies were to examine the prognostic value of several pathological parameters in early stage papillary serous carcinoma of endometrium (PSCE), to evaluate the value of tumor proliferative activity in predicting patient outcome in early stage endometrial carcinomas, and to describe a novel grading system for endometrial carcinoma. To address our first aim, we studied 65 cases of PSCE from patients with International Federation of Gynecology and Obstetric (FIGO) stage I or II disease who were treated at British Columbia Cancer Agency (BCCA) between 1985-1995. In each case, the tumor grade, lymphovascular invasion, and amount of the serous carcinoma component were assessed. p53 immunostaining was performed on 45 tumors. Only FIGO stage was of prognostic significance, and none of the other pathological features examined showed a significant correlation with patient outcome. To address our second aim, the mitotic index, MIB-1 staining index, and p53 immunostaining in 39 tumors from patients with low grade, stage Ia or lb endometrioid carcinoma, and 23 tumors from patients with stage I PSCE were assessed. p53 overexpression and proliferative indices (mitotic and MIB-1) were strongly correlated with each other in low grade endometrioid carcinoma. These markers of proliferative activity are also independent prognostic indicators in these tumors. On the other hand, PSCE are rapidly proliferative tumors even at an early stage, and quantification of proliferative activity in these tumors does not allow prediction of patient outcome. In addressing our third aim, 200 cases of endometrial carcinoma, treated by hysterectomy, were retrieved from the archives of the Dept of Pathology, Vancouver General Hospital, for the period 1983-1998. Each tumor was graded by using three grading systems; FIGO grading, binary grading, and a new grading system, based on the Nottingham grading system used for breast carcinoma. With the new grading system, the tumors are classified based on a combination o f the tumor architecture, nuclear grade, and mitotic index. This new grading system has strong prognostic value, and was found to be an independent predictor of patient outcome when the patient survival was adjusted for FIGO stage, patient age, and tumor cell type.
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