Aggressive stage I grade 1 endometrial carcinoma

Background. Patients with Stage I Grade 1 endometrial carcinoma have an excellent prognosis and a 10‐year survival rate of more than 90%. In every clinical series, however, a few patients in this group have recurrence and die of their disease. Methods. The authors reviewed 80 patients with Stage I Grade 1 endometrial carcinoma treated at their institution from 1955–1980. Eight patients died of recurrent disease within 4 years of diagnosis. The authors studied multiple clinical and histopathologic features, estrogen receptor (ER) and progesterone receptor (PR) status, DNA flow cytometric characteristics, and the expression of c‐myb, H‐ras, and neu oncogenes. Results were compared with those for a control group of 11 patients who survived more than 10 years free of disease. Results. The authors identified the following four statistically significant adverse prognostic factors: myo‐metrial invasion, vascular invasion, 8 or more mitoses per 10 high‐power fields, and an absence of PR. Residual tumor, aneuploidy, and high proliferative activity were associated with a more aggressive behavior, although the relationship did not reach statistical significance. Conclusions. All patients who died of disease within 4 years had tumors with two or more of the significant adverse prognostic factors. Cancer 1992; 70:790–798.