1. ¹Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
2. ²Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
3. ³Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, San Francisco Comprehensive Cancer Center, 1600 Divisidero, San Francisco, CA 94115, USA
4. ⁴Division of Hematology/Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine – Medical Center, 101 The City Drive, Orange, CA 92868, USA
5. ⁵Department of Pathology, 300 Pasteur Drive, Stanford, CA 94305, USA
6. ⁶Divison of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4911 Barnes Hospital Plaza, St Louis, MI 63110, USA
7. ⁷Department of Radiation Oncology, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA

Correspondence: Dr JK Chan, E-mail: johnchan@stanford.edu

Received 24 October 2005; Revised 19 January 2006; Accepted 23 January 2006; Published online 21 February 2006.

Abstract

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.