On the prognosis and treatment of early stage endometrial carcinoma : Studies with special reference to uterine papillary serous carcinoma

Sammanfattning: The prognosis and therapy in the subgroup of endometrial malignancies called Uterine Papillary Serous Carcinoma (UPSC) was investigated. This entity constitutes about 6-8 % of all endometrial carcinomas clinical stage I but, as has been shown here, accounts for one third of the cancer mortality in the early stages of endometrial carcinoma.-The prognostic significance of nuclear atypia, FIGO grade and age was determined in patients with clinical stage 1-11 Uterine Papillary Serous Carcinoma.-DNA-index and S-phase fraction, determined by flow cytometry on formalin-fixed, paraffin-embedded endometrial curettage material was evaluated in relation to nuclear atypia, FIGO grade and age in early stage endometrial carcinoma.-A new method of minimizing the dilution of non-epithelial cells in the malignant curettage material when performing flow cytometry was developed.-The survival and pattern of metastasis in a population-based patient material was investigated -The effects on survival of a new aggressive treatment regimen was assessed.The results show that: Patients with uterine papillary serous carcinoma have a much worse prognosis than do patients with ordinary endometrial carcinoma.DNA ploidy and S-phaseratederived from flow cytometryperformed on disintegrated, previously paraffinembedded, endometrial curettings are important prognostic factors.It is possible to exclude contaminating non-epithelial cells from the DNA analysis by the use of an anticytokeratin antibody, Patients with uterine papillary serous carcinoma clinical stage I have a significantly higher risk of recurrence than patients with non-UPSC. The localisation of the recurrences among the UPSC patients is more similar to that of serous papillary ovarian carcinoma than that of ordinary adenocarcinoma of the endometrium. A primary treatment ofUPSC with a more extensive surgery, adjuvant external radiation and platinum-based chemotherapy seems to improve the outcome.