Surrogates of Progression-Free Survival in Endometrial Cancer Patients: An Evaluation of Tissue Composition [19J]

Abstract

INTRODUCTION: Endometrial cancer (EC) is a heterogeneous disease that varies in tumor composition. The goal of this study was to determine if the composition of endometrial tumors have potential prognostic value. METHODS: Tissue composition of frozen tumors and clinical outcome data were downloaded from the Cancer Genome Atlas (TCGA) Uterine Corpus Endometrial Carcinoma project. Tumors were scored by TCGA pathologists for percent tumor cellularity, necrosis, stromal cells, lymphocytes, monocytes, and neutrophils. The relationship between these measures of tissue composition and clinical outcome were evaluated using log-rank test and Cox modeling. Relationships with clinical characteristics were evaluated using Fisher exact testing. RESULTS: There were 547 evaluable EC patients, including 28% with advanced stage, 75% with endometrioid histology and 21% with serous cancers. Presence versus absence of necrosis, stromal cells, or neutrophils in the tumor samples was associated with worse progression-free survival (PFS) and an increased risk of disease progression (P < .05). The presence of necrosis in the research sample was also an independent surrogate of poor PFS in EC patients after adjustments for stage, cell type, grade and myometrial invasion (hazard ratio=1.56, P=.044). Necrosis was more common in patients with advanced stage (P=.012), higher grade (P < .0001), and deeper myometrial invasion (P < .0001). CONCLUSION: The presence versus absence of necrosis in EC tumors is a promising surrogate of poor versus good prognosis for EC patients with independent prognostic value after adjustment for stage, cell type and tumor grade.