Predictors of endometrial carcinoma in patients with atypical endometrial hyperplasia at a tertiary gynaecological cancer centre in Western Australia.

Autor: Rajadurai VA; Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia., Chivers P; Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.; Exercise Medicine Research Institute & School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia., Ayres C; Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia., Mohan GR; Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.; School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.; Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia., Stewart CJR; Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.; Department of Histopathology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia., Leung YC; Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.; Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia., Wan KM; Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia., Cohen PA; Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.; Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.; Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.; Division of Gynaecological Oncology, St John of God Subiaco Hospital, Perth, Western Australia, Australia.
Jazyk: angličtina
Zdroj: The Australian & New Zealand journal of obstetrics & gynaecology [Aust N Z J Obstet Gynaecol] 2021 Apr; Vol. 61 (2), pp. 275-283. Date of Electronic Publication: 2021 Jan 06.
DOI: 10.1111/ajo.13300
Abstrakt: Aim: Our objective was to assess clinical and pathological factors associated with a final diagnosis of endometrial carcinoma in patients with atypical endometrial hyperplasia with a particular emphasis on the grading of atypia.
Materials and Methods: A retrospective review over five years on patients (N = 97) who underwent hysterectomy for a diagnosis of atypical endometrial hyperplasia at a statewide public tertiary gynaecologic oncology centre. Clinical and pathological characteristics were obtained.
Results: The rate of concurrent endometrial carcinoma was 34% (n = 33) with most being stage 1A endometrioid. A significant group difference was reported for age at diagnosis (t = -2.20 P = 0.031 d = 0.43) with carcinoma patients on average older (M age  = 60.2 (8.9) years) than patients without carcinoma (M age  = 55.5 (12.3) years). No significant group differences were found for body mass index, endometrial thickness or time between diagnosis and treatment. Significantly higher rates of carcinoma were reported in patients with moderate atypical hyperplasia (27.6%) and severe atypical hyperplasia (66.7%), compared to mild atypical hyperplasia (7.1%). Only severe atypical hyperplasia (odds ratio (OR) = 21.5, 95% CI 2.8-163.1, P = 0.003) and postmenopausal status (OR = 13.2, 95% CI 1.3-139.0, P = 0.032) significantly increased the risk of carcinoma in a multivariate model.
Conclusion: Severe atypical hyperplasia and postmenopausal status were significant predictors of concurrent endometrial carcinoma in patients with atypical endometrial hyperplasia. The grading of atypical hyperplasia may be utilised by gynaecologic oncologists in the triage and referral process of managing these patients; however, the grading system requires external validation in larger prospective studies.
(© 2021 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)
Databáze: MEDLINE
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