Background: Endometrial carcinoma is one of the most common gynecological malignancies worldwide. Histological grading plays a crucial role in determining tumor aggressiveness, recurrence risk, treatment planning, and survival outcomes. Although tumor stage remains the most powerful prognostic factor, grade provides additional prognostic information, especially in early-stage disease.

Objective: To evaluate the association between histological grading and survival outcomes in patients with endometrial carcinoma.

Materials and Methods: A retrospective observational study was conducted on 180 histopathologically confirmed cases of endometrial carcinoma diagnosed over five years. Tumors were evaluated for histological type, grade, depth of myometrial invasion, lymphovascular invasion, cervical stromal involvement, lymph node metastasis, and recurrence. Survival outcomes were analyzed according to tumor grade.

Results: Endometrioid adenocarcinoma was the most common histological type, accounting for 82.2% of cases. Grade 1 tumors constituted 38.9%, Grade 2 tumors 34.4%, and Grade 3 tumors 26.7%. Higher histological grade was significantly associated with deep myometrial invasion, lymphovascular invasion, lymph node metastasis, recurrence, and reduced overall survival. Five-year survival was highest in Grade 1 tumors and lowest in Grade 3 tumors.

Conclusion: Histological grading is a significant prognostic parameter in endometrial carcinoma. Higher tumor grade correlates with aggressive pathological features and poorer survival outcomes. Accurate grading should be routinely incorporated into pathology reporting to guide risk stratification and treatment planning.