Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers

To compare the survival of women with uterine papillary serous carcinoma ( UPSC) and clear cell carcinoma ( CC) to those with grade 3 endometrioid uterine carcinoma ( G3EC). Demographic, pathologic, treatment, and survival information were obtained from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001. Data were analysed using Kaplan - Meier and Cox proportional hazards regression methods. Of 4180 women, 1473 had UPSC, 391 had CC, and 2316 had G3EC cancers. Uterine papillary serous carcinoma and CC patients were older ( median age: 70 years and 68 vs 66 years, respectively; P < 0.0001) and more likely to be black compared to G3EC ( 15 and 12% vs 7%; P < 0.0001). A higher proportion of UPSC and CC patients had stage III - IV disease compared to G3EC patients ( 52 and 36% vs 29%; P < 0.0001). Uterine papillary serous carcinoma, CC and G3EC patients represent 10, 3, and 15% of endometrial cancers but account for 39, 8, and 27% of cancer deaths, respectively. The 5- year disease- specific survivals for women with UPSC, CC and G3EC were 55, 68, and 77%, respectively ( P < 0.0001). The survival differences between UPSC, CC and G3EC persist after controlling for stage I - II ( 74, 82, and 86%; P < 0.0001) and stage III - IV disease ( 33, 40, and 54; P < 0.0001). On multivariate analysis, more favourable histology ( G3EC), younger age, and earlier stage were independent predictors of improved survival. Women with UPSC and CC of the uterus have a significantly poorer prognosis compared to those with G3EC. These findings should be considered in the counselling, treating and designing of future trials for these high- risk patients.