The presence of an endometrioid component does not alter the clinicopathologic profile or survival of patients with uterine serous cancer: A gynecologic oncology group (GOG/NRG) study of 934 women

Ian S. Hagemann, Wei Deng, Richard J. Zaino, Matthew A. Powell, Camille Gunderson, Casey Cosgrove, Cara Mathews, Michael L. Pearl, Steven Waggoner, Rahel Ghebre, Shashikant Lele, Saketh Guntupalli, Angeles Alvarez Secord, Olga Ioffe, Kay Park, Golnar Rasty, Meenakshi Singh, Robert Soslow, William Creasman, David G. Mutch

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective: While most cases of endometrial cancer can readily be classified as pure endometrioid, pure serous, or another type, others show an apparent mixture of serous and endometrioid components, or indeterminate serous versus endometrioid features. Since serous histology carries a worse prognosis than endometrioid, Gynecologic Oncology Group protocol GOG-8032 was established to examine whether the presence of a non-serous component is a favorable feature in an otherwise serous cancer. Methods: 934 women with serous cancer were prospectively identified among a larger group enrolled in GOG-0210. Six expert gynecologic pathologists classified each case as pure serous (SER, n=663), mixed serous and endometrioid (SER-EM-M, n=138), or indeterminate serous v. endometrioid (SER-EM-I, n=133) by H&E morphology. Follow-up data from GOG-0210 were analyzed. Results: The subgroups did not differ on BMI, race, ethnicity, lymphovascular invasion, cervical invasion, ovary involvement, peritoneal involvement, omental involvement, FIGO stage, or planned adjuvant treatment. SER-EM-M patients were younger (p=0.0001) and less likely to have nodal involvement (p=0.0287). SER patients were less likely to have myoinvasion (p=0.0002), and more likely to have adnexal involvement (p=0.0108). On univariate analysis, age, serous subtype, race, and components of FIGO staging predicted both progression-free and overall survival. On multiple regression, however, serous subtype (SER, SER-EM-M, or SER-EM-I) did not significantly predict survival. Conclusions: There were few clinicopathologic differences between cases classified as SER, SER-EM-M, and SER-EM-I. Cases with a mixture of serous and endometrioid morphology, as well as cases with morphology indeterminate for serous v. endometrioid type, had the same survival as pure serous cases.

Original languageEnglish (US)
Pages (from-to)660-668
Number of pages9
JournalGynecologic oncology
Issue number3
StatePublished - Mar 1 2021

Bibliographical note

Funding Information:
Dr. Pearl received a grant from the Gynecologic Oncology Group. He also has grants/grants pending from GOG/NIH. He has received Royalties from Vivitek, Inc. via SBU Research Foundation.

Funding Information:
Dr. Mathews reports grants from Syros, Deciphera, AstraZeneca, Astellas Pharma, Tesaro/GSK, Seattle Genetics and Regeneron outside the submitted work.

Funding Information:
Dr. Park received grant funding from NIH/NCI P30 CA008748.

Funding Information:
This study was supported by National Institute of Health grants to NRG Oncology ( 1U10 CA180822 ) and NRG Operations ( U10CA180868 ), NCORP ( UG1CA189867 ), NRG Specimen Bank ( U24CA196067 ), and was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748 .

Publisher Copyright:
© 2021 Elsevier Inc.


  • Endometrial carcinoma
  • Endometrioid carcinoma
  • Malignant mixed tumors
  • Pathology
  • Serous carcinoma
  • Survival analysis


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