Squamous differentiation portends poor prognosis in low and intermediate-risk endometrioid endometrial cancer

Autoři: Diocesio Alves Pinto de Andrade aff001;  Vinicius Duval da Silva aff003;  Graziela de Macedo Matsushita aff003;  Marcos Alves de Lima aff004;  Marcelo de Andrade Vieira aff005;  Carlos Eduardo Mattos Cunha Andrade aff005;  Ronaldo Luís Schmidt aff005;  Rui Manuel Reis aff002;  Ricardo dos Reis aff005
Působiště autorů: Departament of Oncology, InORP ONCOCLÍNICAS Group (Oncology Institute of Ribeirão Preto), Ribeirão Preto, São Paulo, Brazil aff001;  Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil aff002;  Departament of Pathology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil aff003;  Epidemiology and Biostatistics Nucleus, Barretos Cancer Hospital, Barretos, São Paulo, Brazil aff004;  Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil aff005;  Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal aff006;  ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0220086



Endometrial cancer presents well-defined risk factors: myometrial invasion, histological subtype, tumor grade, lymphovascular space invasion (LVSI). Some low and intermediate-risk endometrioid endometrial cancer patients exhibited unexpected outcomes. This study aimed to investigate other clinical-pathological factors that might influence the recurrence rates of patients diagnosed with low and intermediate-risk endometrioid endometrial cancer.


A case-control study from a cohort retrospective of 196 patients diagnosed with low and intermediate-risk endometrioid endometrial cancer at a single institution from 2009 to 2014 was conducted. Medical records were reviewed to compare clinical (race, smoking, menopause age, body mass index) and pathological (endometrioid vs endometrioid with squamous differentiation, tumor differentiation grade, tumor location, endocervical invasion, LVSI) features of patients with recurrence (case) and without recurrence (control) of disease. Three controls for each case were matched for age and staging.


Twenty-one patients with recurrence were found (10.7%), of which 14 were stage IA, and 7 were stage IB. In accordance, 63 patients without recurrence were selected as controls. There were no significant differences in any clinical characteristics between cases and controls. Among pathological variables, presence of squamous differentiation (28.6% vs. 4.8%, p = 0.007), tumor differentiation grade 2 or 3 (57.1% vs. 30.2%, p = 0.037) and presence of endocervical invasion (28.6% vs. 12.7%, p = 0.103) were associated with disease recurrence on a univariate analysis. On multivariable analysis, only squamous differentiation was a significant risk factor for recurrence (p = 0.031).


Our data suggest that squamous differentiation may be an adverse prognostic factor in patients with low and intermediate-risk endometrioid endometrial cancer, that showed a 5.6-fold increased risk for recurrence.

Klíčová slova:

Cancer detection and diagnosis – Differentiated tumors – Histology – Prognosis – Surgical and invasive medical procedures – Surgical oncology – Uterine cancer


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