Prognostic factors of endometrial carcinoma -: a comparison of clinical and immunohistochemically defined parameters

Purpose: While most endometrial carcinomas are detected in an early stage of disease, about 20% advance to later stage disease at the time of diagnosis. This study aimed to investigate which factors contribute to an advanced tumor stage at time of diagnosis. Material and Method: Follow-up and histopathological factors (myometrial invasion, histologic type, grading, lymphangiosis, and hemangiosis carcinomatosa, and necrosis) were reevaluated in 183 patients with endometrial carcinoma and their archived tumor tissue. In addition the expression of estrogen and progesterone receptor, fibronectin and FSAP was studied immunohistochemically using the streptavidin-biotin technique. The prognostic value of parameters was analyzed by the Kaplan-Meier method. Bivariate correlation and discriminant analysis were used to identify the most important factors leading to an advanced stage at diagnosis. Results: FIGO stage and hemangiosis carcinomatosa are the most important prognostic factors in endometrial carcinoma. Lymphangiosis carcinomatosa is identified as the most important factor of tumor progression (Wilk's Lambda = 0.719; chi(2) = 50.3; df = 3; p < 0.001), followed by grading and necrosis. Conclusion: This study suggests that some patients present with advanced stages disease due to the qualitative biological aspects of the tumor and not only because of deficits in diagnostic proceedings. Based on the data presented in this investigation concerning lymphangiosis and hemangiosis carcinomatosa these parameters should be noted in every histopathological report and furthermore they might be useful to decide the extent of adjuvant therapy.