Treatment Delay in Endometrial Cancer

TO THE EDITOR: I read with great interest the population-based study entitled “Impact of Wait Times on Survival for Women With Uterine Cancer” by Elit et al in the January 1 issue of Journal of Clinical Oncology. The authors concluded that longer wait times from diagnosis to surgery have a negative impact on survival. However, in this study, almost 23% of the patients had histological types of endometrial cancer (clear-cell carcinoma, serous carcinoma, adenosquamous carcinoma, and sarcoma) that are known to behave differently than endometrial endometrioid carcinoma and also known to have a unfavorable prognosis. In contrast, our study, cited by the authors, that found that a delay had no impact on prognosis, included only patients with endometrial endometrioid carcinoma. Our findings are also supported by several other studies. Indeed we reported a prolonged survival in a small series of untreated patients with endometrial endometrioid cancer and patients with a prolonged treatment delay. This seems to indicate that the natural progression course, even in untreated patients, may be slow in endometrial endometrioid carcinoma with favorable prognostic factors.