The effect of age on prediction of concurrent endometrial cancer in patients with atypical endometrial hyperplasia

Purpose: To evaluate the effect of age on prediction of concurrent endometrial cancer (EC) in patients with atypical endometrial hyperplasia (AEH). Materials and Methods: Medical data of 176 patients who were diagnosed with atypical endometrial hyperplasia and underwent surgical treatment enrolled the study group. Clinicopathological features, preoperative and postoperative information were collected. The age distrubition for patients with atypical endometrial hyperplasia and endometrial cancer were examined and stratified according to five-year age increments. Results: Concurrent endometrial cancer was detected in 35(19.8%) patients. atypical endometrial hyperplasia and lower grade hyperplasia (simple or complex) was found in 82(46.5%) and 27(15.3%) patients, respectively. Endometrial cancer was most frequently seen in 51-60 age group. Endometrial cancer in final pathology significantly increased (p = 0,0005) after the age of 53 with sensitivity of 65.52% and 76.67%. Conclusion: Endometrial cancer increases significantly after the age of 53 in patients with atypical endometrial hyperplasia. Based on this study it is recommended that clinicians shoud be aware of this knowledge while informing patients and planning treatment.

Age; Atypical endometrial hyperplasia (AEH); Endometrial cancer (EC)

[1] Torre L.A., Bray F., Siegel R.L., Ferlay J.,Lortet J.,Jemal A.: “Global cancer statistics, 2012”. CA Cancer J. Clin., 2015, 65, 87.

[2] Siegel R.L., Miller K.D., Jemal A.: “Cancer statistics”. CA Cancer J. Clin., 2016, 66, 7.

[3] Jamison P.M., Noone A.M., Ries L.A., Lee N.C., Edwards B.K.: “Trends in endometrial cancer incidence by race and histology with a correction for the prevalence of hysterectomy, SEER 1992 to 2008”. Cancer Epidemiol. Biomarkers Prev., 2013, 22, 233.

[4] Elshaikh M.A., Munkarah A.R., Robbins J.R., Lazer B.S., Bhatt N, Cogan C., et al.: “The impact of race on outcomes of patients with early stage uterine endometrioid carcinoma”. Gyneco. Oncol., 2013, 128, 171.

[5] Bokhman J.V.: “Two pathogenetic types of endometrial carcinoma”. Gynecol. Oncol., 1983, 15, 10.

[6] Hedrick E.L., Ronnett B.M., Kurman R.J.: “Precursor lesions of en- dometrial carcinoma”. In: Kurman R.J., Hedrick Ellenson L., Ronnett B.M., (eds). Blaustein’s Pathology of the Female Genital Tract. 6th ed. New York: Springer, 2010, 360.

[7] Lacey J.V., Sherman M.E., Rush B.B., Ronnett B.M., Ioffe O.B., Duggan M.A., et al.: “Absolute risk of endometrial carcinoma dur- ing 20-year follow-up among women with endometrial hyperplasia”. J. Clin. Oncol., 2010, 28, 788.

[8] Emons G., Beckmann M.W., Schmidt D., Mallmann P.: “New WHO classification of endometrial hyperplasias”. Geburtshilfe Frauenheilkd, 2015, 75, 135.

[9] Scully R.E, Bonfiglio T.A., Kurman R.J., Silverberg S.G., Wilkinson E. J.: “Uterine corpus, histological typing of female genital tract tumors”. 2nd ed. NewYork: Springer, 1994, 13.

[10] Reed S.D., Newton K.M., Clinton W.L., Epplein M., Garcia R., Allison K., et al.: “Incidence of endometrial hyperplasia”. Am. J. Obstet. Gynecol., 2009, 200, 678.

[11] Trimble C.L., Kauderer J., Zaino R., Silverberg S., Lim P.C., Burke J.J., et al.: “Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study”. Cancer, 2006, 106, 812.

[12] Kurman R.J., Norris H.J.: “Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma”. Cancer, 1982, 49, 2547.

[13] Widra E.A., Dunton C.J., McHugh M., Palazzo J.P.: “Endometrial hyperplasia and the risk of carcinoma”. Int. J. Gynecol. Cancer,1995, 5, 233.

[14] Antonsen S.L., Ulrich L., Hogdall C.: “Patients with atypical hyperplasia of endometrium should be treated in oncolojical centers”. Gynecol .Oncol., 2012, 125, 124.

[15] Yuk J.S. : “The incidence rates of endometrial hyperplasia and endometrial cancer: a four-year population-based study”. PeerJ., 2016, 24, 4, e2374.

[16] Cyril T., Bruno P., Koskas M. Gonthier C., Ballester M., Cortez A., et al.: “Factors predictive of endometrial carcinoma in patients with atypical endometrial hyperplasia on preoperative histology”. Anticanser Res., 2014 , 34, 5671.

[17] Kisielewski F. , Gajewska M.E., Marczewska M.J., Panek G., Wiel- goś M., Kamiński P.: “Comparison of endometrial biopsy and post-operative hysterectomy specimen findings in patients with atypi- cal endometrial hyperplasia and endometrial cancer”. Ginekol Pol., 2016, 87, 488.

[18] Erdema B., Aşıcıoğlua O., Seyhana N.A., Peker N., Ülker V., Akbayır Ö.: “Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia?” Int. J. Surg., 2018, 53, 350.

[19] Matsuo K., Ramzana A.A., Gualtieri M.R., Mhawech F.P., Machida H., Moeini A., et al.: “Prediction of concurrent endometrial carcinoma in women with endometrial hyperplasia”. Gynecol. Oncol., 2015, 139, 261.

[20] Hassa H., Tanir H.M., Senses T., Oge T, Sahin M.F.: “Related factors in bone mineral density of lumbal and femur in natural postmenopausal women”. Arch. Gynecol. Obstet., 2005, 273, 86.

[21] Chen Y.L., Cheng W.F., Lin M.C., Huang C.Y., Hsieh C.Y., Chen C.A.: “Concurrent endometrial carcinoma in patients with a curettage diagnosis of endometrial hyperplasia”. J .Formos Med. Assoc., 2009, 108, 502.

[22] Allison K.H., Reed S.D., Voigt L.F., Jordan C.D., Newton K.M., Garcia R.L.: “Diagnosing endometrial hyperplasia: Why is it so difficult to agree?” Am. J. Surg .Pathol., 2008, 32, 691.