Kjell E. Kjørstad

Clear cell carcinoma of the endometrium: A histopathological and clinical study of 97 cases

In a histopathologic review of 1985 cases of endometrial carcinoma 97 patients (4.9%) had clear cell carcinoma (CCC). Mean age at diagnosis was 65.3 years. The crude 5- and 10-year survivals for all stages were 42.3 and 30.9%, respectively. Fifty-nine percent of the patients in surgicopathological stage I and 27% in stage II survived 5 years. Myometrial infiltration and vessel invasion were important prognosticators. Ninety percent of the patients with intramucosal tumors survived 5 years, in contrast to only 15% of the patients with deep myometrial infiltration. Seventeen percent of the patients with vessel invasion survived 5 years, in contrast to 49% of the patients without this finding. CCC is one of the most aggressive subtypes of endometrial carcinoma.

Clear cell carcinoma of the endometrium: Prognosis and metastatic pattern

To establish the prognosis, metastatic pattern, sites of treatment failure, and effect of various treatment modalities, a large series of patients with endometrial clear cell carcinomas (ECCC) was analyzed.

Endometrial adenocarcinoma in Norway. A study of a total population

Fifteen hundred sixty‐six patients with adenocarcinoma of the endometrioid type (AC) were studied. These accounted for 78.9% of all 1985 patients with confirmed endometrial carcinoma diagnosed in Norway in the period 1970 through 1978. Four hundred and sixty‐nine patients (29.9%) had well‐differentiated tumors, 677 (43.2%) were moderately and 420 (26.8%) poorly differentiated. Eighty‐one percent of the patients had surgicopathologic Stage I disease, 11% Stage II, 6% Stage III, and 2% Stage IV. Mean age at diagnosis was 62.1 years (range, 36 to 91). The crude 5‐year and 10‐year survival rates for all patients were 74.1% and 62.2%, respectively. Five‐year crude survival was 86.8% for Grade 1 and 58.3% for Grade 3 tumors. The 5‐year crude survival for patients with intramucosal tumors was 88.7% as opposed to 46.9% for patients with tumors infiltrating to the serosa. Sixty‐six percent of the patients with vessel invasion survived for 5 years in contrast to 88.6% for patients without vessel invasion. Histologic grade, myometrial infiltration, vessel invasion, and lymphocyte reaction surrounding the tumor were strongly interrelated. Multivariate analysis showed that the age of the patient at the time of diagnosis was the most important single prognostic factor. Disregarding age, survival in operated patients was more dependent on the depth of myometrial invasion than on grade and stage of disease.

Randomized trial comparing cisplatin with radioactive phosphorus or whole-abdomen irradiation as adjuvant treatment of ovarian cancer

In this study, 347 patients with epithelial ovarian cancer without residual tumor after primary laparotomy, were assigned randomly to receive either intraperitoneal instillation of radioactive phosphorus (32P) or six courses of cisplatin (50 mg/m2. Patients randomized to receive 32P with extensive intraperitoneal adhesions were treated with whole‐abdomen irradiation instead of 32P (n = 28). The median follow‐up was 62 months. Crude and disease‐free survival were similar in all groups. Late bowel complications occurred more often in patients treated with 32P compared with the cisplatin group. The estimated 5‐year crude survival rate was as high as 95% in patients with borderline or well‐differentiated tumors in Stage I. It is suggested that these patients can be treated adequately by operation alone. Patients with moderately or poorly differentiated cancers in Stage I disease had a 5‐year crude survival rate of 75%. In these patients, the relapse risk was high enough to warrant postoperative treatment. The efficacy of adjuvant treatment in this subgroup of patients can only be established in a prospective randomized study comparing postoperative adjuvant treatment with a no‐treatment arm. Because of the high number of late bowel complications after 32P treatment, it was recommended that cisplatin be used as standard adjuvant treatment for subsequent controlled studies.

A randomized trial of adjuvant progestagen in early endometrial cancer.

A randomized, controlled trial was designed to determine whether adjuvant progestagen therapy improves survival in patients with Stage I or Stage II endometrial cancer. After surgery, 1148 patients were randomly assigned to adjuvant treatment with progesterone or were given no additional therapy. The duration of follow‐up ranged from 42 to 132 months (median follow‐up, 72 months). Crude survival and relapse rates were similar for both groups. Death due to intercurrent disease was higher in the progesterone group (P = 0.04). The median survival of the group of patients with cancer‐related death was higher in the progestagen group than in the control group (30 and 22 months, respectively; P = 0.03). In 461 high‐risk patients, a tendency towards fewer cancer‐related deaths and a better disease‐free survival in the treatment group was observed, but crude survival was unchanged. We conclude that there is little to gain from adjuvant progestagen therapy in patients with low‐risk endometrial cancer, and that further studies are needed in high‐risk patients.

Serous papillary carcinoma of the endometrium : a histopathological study of 22 cases

Abstract In a histological review of all 1985 cases of endometrial carcinoma in Norway diagnosed in the period 1970 through 1977, 22 patients (1.1%) with serous papillary carcinoma (ESPC) were identified. Mean age at diagnosis was 72 years, which was significantly higher than for patients with ordinary adenocarcinoma. All patients were followed at least 10 years. The crude 5- and 10-year survival rates were 27 and 14%. Only three patients survived longer than 10 years and all of these had had stage I tumors. In 19 available curettage specimens ESPC could be identified in 18. This could have implications regarding choice of therapy because this subtype of endometrial carcinoma is very aggressive. It is most often found in elderly women.

Adenocarcinoma of the uterine cervix.

Abstract One hundred and two cases of adenocarcinoma of the cervix treated from 1963 to 1968 were analyzed. The overall treatment results were poorer than for patients with squamous cell carcinoma treated in the same period. Comparing the results in this series with those of an earlier report from the same institution, it was found that the prognosis had improved only in early cases of adenocarcinoma and that this improvement was linked to increased use of surgery. Data presented suggest a possible biological difference in tumors developing before and after the menopause.

Stage IB carcinoma of the cervix, the Norwegian Radium Hospital: Results and complications: III. Urinary and gastrointestinal complications

The combination of surgery and radiotherapy for early cases of cancer of the cervix has been accused of producing prohibitive complication rates. In a series of 612 patients with cancer of the cervix, Stage IB, the frequency of major complications from the urinary and gastrointestinal tract has been studied, and an attempt has been made in determining the most probable etiology of these complications. No significant increase in complications can be attributed to the use of preoperative intracavitary irradiation. In patients with pelvic lymph node metastases the combination of radical surgery and a full course of radiotherapy is associated with a high complication risk, as 12% of these patients developed major complications. Their 5-year survival, however, was high: 54%.

The value of complete lymphadenectomy in radical treatment of cancer of the cervix, stage IB

Two hundred ninety‐three patients with Stage IB carcinoma of the uterine cervix were treated by intracavitary irradiation followed by radical hysterectomy and pelvic lymph node dissection in the 3‐year period 1970 to 1972, inclusive. Preoperative lymphography was performed and intraoperative films were taken to obtain a lymphadenectomy that was as complete as possible. The number and location of remaining nodes were determined by postoperative films. No patients were lost to follow‐up. The 5‐ and 10‐year survival and recurrence rates were correlated to the number of remaining nodes. It is concluded that patients with four or more remaining nodes have a possible inferior prognosis compared with the rest of the patients. Meticulous and time‐consuming search for a few remaining nodes was, however, not found to be justified.

Endometrial adenocarcinoma with squamdus cell differentiation

In a histopathologic review of all cases of endometrial carcinoma diagnosed in Norway between 1970 and 1978, 255 cases of adenocarcinoma with squamous cell differentiation were found among the 1985 cases reviewed. One hundred eighty‐one (9.1%) were adenoacanthoma and 74 (3.7%) adenosquamous carcinoma. The mean age for patients with adenoacanthoma was 57.7 years (range, 32 to 85 years) and for adenosquamous carcinoma, 62.8 years (range, 43 to 84 years). Five‐year and 10‐year survival rates for all patients were 83.5% and 71.8%, respectively. For patients with adenosquamous carcinoma, corresponding figures were 64.9% and 52.7%, and for those with adenoacanthoma, the figures were 91.2% and 79.6%, respectively. When stratified for grade and depth of myometrial infiltration, there was no difference in survival rates between patients with adenoacanthoma and adenosquamous carcinoma, provided hysterectomy was part of the primary treatment. In patients who had surgery, myometrial infiltration was the most important single prognostic factor. It is recommended that the terms adenoacanthoma and adenosquamous carcinoma be replaced by the descriptive term adenocarcinoma with squamous cell differentiation.