Clinical analysis of endometrial carcinoma patients under 45 years of age

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Gao Jinsong king and Huang Huifang Pan Lingya Kenglang Shen Ying Wu beat Chen Qionghua[Abstract] Objective: To summarize the clinical featur

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Gao Jinsong king and Huang Huifang Pan Lingya Kenglang Shen Ying Wu beat Chen Qionghua

[Abstract] Objective: To summarize the clinical features of 45 year old patients with endometrial carcinoma. Methods: a retrospective analysis of clinical data in our hospital from January 1982 to April 2003 were under 45 years old in 52 cases of endometrial cancer patients, and divided into 35 years of age (group A, 17 cases) and older group (group B, 35 cases) were compared and analyzed. Results: under the age of 45 endometrial cancer endometrial cancer patients accounted for 12.7% of the total, with the increase of age, the incidence rate increased, about 50% of the patients did not produce, infertility, menstrual disorders, endometrial hyperplasia, 28.9% obese, 23.1% with polycystic ovary, the combination of A and polycystic ovary ratio was 52.9% the proportion, with atypical endometrial hyperplasia was 58.8%, significantly higher than that in group B (8.6%, 25.8%), the difference was statistically significant. FIGO stage I accounted for 82.5%, of which A group were I stage endometrioid carcinoma, B group of patients with high risk factors accounted for the proportion of, but in addition to the FIGO staging has an increasing trend (p< 0.05), the rest were not statistically different. 2 patients were treated with progesterone to preserve fertility. 2 cases recurred. Conclusion: younger endometrial carcinoma with infertility, menstrual disorders, obesity, polycystic ovarian endometrial hyperplasia, a higher proportion, indicating that their occurrence is related to estrogen, stage to I stage, especially < 35 years of age, risk factors, prognosis. Fertility preservation or ovarian function may be considered in patients with early-stage endometrial cancer.

Endometrial carcinoma; endometrial hyperplasia; polycystic ovary

Clinical analysis of endometrial carcinoma patients age 45 years and younger GAO Jin-song, SHEN Ken, LANG Jing-he, HUANG Hui-fang, PAN Ling-ya, Wu Ming, Jin Yin, Chen Qiong-hua. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College, Chinese Academy of Medical Sciences Beijing, 100730, China.

[Abstract] Objective To analysis the clinical characteristics and outcome of endometrial carcinoma patients age years and younger. Method From 45 Jan.1982 to Apr.2003, of endometrial carcinoma 52 cases age 45 years and younger were treated in PUMCH. They were further devided into group A (35 years of age and younger and group (older) B than 35 years Clinical). Data of these young patients was reviewed and the two groups were compared. Results Patients age 45 years and younger account of all the endometrial carcinoma 12.7% patients. About 50% of the patients were nulliparious, infertile or had irregular menstruation and endometrial hyperplasia were, 28.9% obese, 23.1% had polycystic ovaries. Group A had more polysystic ovaries and atypical Endometrial hyperplasia than group B (52.9% vs 8.6%, 58.8% vs 25.8% accordingly, p< 0.05). And 82.5% of the patients were stage I (FIGO, 1988). All group A patients were stage I endometriod carcinoma. In group B, 25.7% had risk factors, but there were no statistical significance compared with group A except FIGO stage which was higher in group B (p< 0.05). Operation was the main treatment. Two patients were treated successfully with conservative high dose progestin. Two patients relapsed. Conclusions There were high incidence of infertility, irregular menstrution, endometrial hyperplasia, obese and ploycystic ovaries in young patients age 45 years and younger, indicating its relationship with estrogen. Most patients, especially those yo Uner than 35 years age of, were I few, with risk factors good prognosis, Conservation of and ovarian function should be considered in these patients. fertility and

[Key Words] endometrial carcinoma; endometrial hyperplasia; PO lycystic ovary

Endometrial carcinoma is one of the most common gynecologic malignancies, especially in postmenopausal women. This paper summarized the clinical characteristics of 45 cases of endometrial carcinoma under the age of 52 in our hospital.

Materials and methods

Methods from January 1982 to April 2003, 45 patients with endometrial carcinoma in our hospital were selected, and their clinical data were reviewed. The clinical characteristics were analyzed and divided into 35 groups (A group) and 35-45 years old group (group B), and the clinical characteristics were compared between the two groups.

Statistical analysis using SPSS10.0 software package, including t test, chi square test 2.

Result

1, the basic situation: under the age of 45 endometrial cancer patients in 52 cases, accounted for 12.7% of endometrial carcinoma (52/410), which is less than 25 years old in 4 cases, 26 to 30 years old in 5 cases, 31 to 35 years old in 8 cases, 36 to 40 years old in 15 cases, 20 cases of 41 ~ 45 years old, the minimum age is 24 at the age of 35 years old, and below accounted for only 4.1%, with the increase of age, the incidence has increased. The average pregnancy and birth times of group A were lower than those of group B (P< 0.05). The A group did not produce, infertility, menstrual disorders, obesity, polycystic ovary, endometrial hyperplasia and atypical hyperplasia ratio higher than group B, which did not produce the ratio of 88.2% and 48.6%, with polycystic ovary were 52.9% and 8.6%, with endometrial atypical hyperplasia and 58.8% cases respectively than 25.8%, the difference was statistically significant. The patients with hypertension and diabetes were less. Another 5 cases (9.6%) were complicated with early ovarian cancer, and there was no significant difference between the A group and the B group (n = 11.8% and 8.6%, respectively). (Table 1)

2, symptoms (see Table 1): the symptoms of the patients (96.2%) were mainly abnormal vaginal bleeding (84.6%), followed by menorrhagia, lower abdominal pain and vaginal fluid flow (50). There are 2 cases with no obvious symptoms, including 1 cases with uterine fibroids were found in operation, the other 1 cases for diagnosis of cervical biopsy neoplasm. There was no difference in clinical symptoms between the two groups.

Table 1 clinical characteristics of young patients with endometrial carcinoma

(n=52)

= 35 years group (A)

(n = 17)

35-45 years old group (B)

(n = 35)

The value of P

Group vs B group (group A)

Average age

Thirty-six point nine

29.2 (24 ~ 35)

40.6 (36 ~ 45)

Mean gestational age

0.83 + 2.16

0.29 + 0.94

1.09 + 2.4

Zero point zero one two

Average yield

0.44 + 1.28

0.12 + 0.66

0.60 + 1.38

Zero point zero zero nine

Not all

32 (58.2%)

15 (88.2%)

17 (48.6%)

Zero point zero zero seven

Sterile

25 (48.1%)

11 (64.7%)

14 (40%)

NS

polycystic ovary

12 (23.1%)

9 (52.9%)

3 (8.6%)

Zero point zero zero one

Menstrual disorder

25 (48.1%)

11 (64.7%)

14 (40%)

NS

Obesity

15 (28.9%)

6 (35.3%)

9 (25.7%)

NS

Diabetes

5 (9.6%)

5 (14.3%)

NS

Hypertension

2 (3.8%)

2 (5.7%)

NS

Ovarian cancer

5 (9.6%)

2 (11.8%)

3 (8.6%)

NS

Endometrial hyperplasia

Atypical hyperplasia

23 (44.2%)

19 (36.5%)

11 (64.7%)

10 (58.8%)

12 (34.2%)

9 (25.8%)

Zero point zero seven three

Zero point zero three two

Symptom

Irregular bleeding

Menorrhagia

Vaginal fluid

Abdominal pain

44 (84.6%)

8 (15.4%)

3 (5.8%)

8 (15.4%)

15 (88.2%)

2 (11.8%)

3 (17.6%)

29 (82.9%)

6 (17.1%)

3 (8.6%)

5 (14.7%)

NS

NS

NS

NS

3, risk factors: 52 patients in 50 cases (90.2%) for endometrial cancer, high, middle and low differentiation accounted for 69.2%, 17.3% and 9.6%, according to FIGO (1988) staging (including 9 cases without preoperative radiotherapy or surgery for clinical stage, after the same), I, II III, and IV accounted for 82.7%, 5.8%, 9.6% and 3.8%. A group of 17 cases were endometrioid carcinoma stage I, Ia, Ib and Ic were 5 (29.4%), 11 (64.7%), 1 (5.9%), except for 1 cases of low differentiated deep myometrial invasion outside (5.9%), the remaining patients without risk factors (mainly refers to: low differentiation deep myometrial invasion, ascites cells positive, adnexal metastasis, lymph node metastasis, lymph vessel metastasis) clearance. There were 9 patients () in the B group (P> = 0.05), including clear cell carcinoma. Compared with the two groups, the B group had an increasing trend, and there was no significant difference in other risk factors.

Table 2 Comparison of high risk factors of endometrial carcinoma in young women

(n=52)

= 35 years group (A)

(n = 17)

35-45 years old group (B)

(n = 35)

The value of P

Pathology:

Endometrioid adenocarcinoma

Non endometrioid carcinoma

50 (96.2%)

2 (3.8%)

17 (100%)

33 (94.3%)

2 (5.7%)

NS

Classification

G1

G2

G3

Unknown

36 (69.2%)

9 (17.3%)

5 (9.6%)

2 (3.8%)

13 (76.3%)

3 (17.8%)

1 (5.9%)

23 (65.7%)

6 (17.1%)

4 (11.5%)

2 (5.7%)

NS

FIGO staging *

I

II

III

IV

43 (82.7%)

3 (5.8%)

5 (9.6%)

1 (1.9%)

17 (100%)

26 (74.3%)

3 (8.6%)

5 (14.3%)

1 (2.9%)

< 0.05< p=" " >

Myometrial invasion

nothing

Superficial muscular layer

Deep muscular layer

Unknown

13 (25%)

28 (53.8%)

5 (9.6%)

6 (11.5%)

2 (11.8%)

11 (64.7%)

1 (5.9%)

3 (17.6%)

11 (31.4%)

17 (48.6%)

4 (11.4%)

3 (8.6%)

NS

Cervical involvement

nothing

Gland

Interstitial

Unknown

42 (80.8%)

2 (3.8%)

1 (1.9%)

7 (13.5%)

13 (76.5%)

4 (23.5%)

29 (82.9%)

2 (5.7%)

1 (2.9%)

3 (9.6%)

Positive ascites cytology

1 (1.9%)

1 (2.9%)

NS

Lymph node metastasis

1 (1.9%)

1 (2.9%)

NS

Attachment transfer

1 (1.9%)

1 (2.9%)

NS

Vascular space involvement

1 (1.9%)

1 (2.9%)

NS

No operation (6 cases) or preoperative radiotherapy (n = 3), clinical stage (a total of 9 cases)

4, treatment:

A group of 14 cases (including 2 cases of high dose progesterone conservative treatment failed or abandoned the conservative treatment after surgery), surgery was 82.3%, underwent hysterectomy, 10 cases were unilateral or bilateral ovarian reserve (71.4%), pelvic lymph node dissection in 6 cases (42.9%, 2 cases underwent abdominal aorta. Lymph node dissection), 4 cases of progesterone treatment after operation (28.6%), no postoperative radiotherapy or chemotherapy. This group of patients in 15 cases (88.2%) has not yet fertility, 5 cases (29.4%) treated with large dose of progesterone in clinical stage Ia differentiated endometrioid adenocarcinoma, every March curettage once, until the normal endometrium after progesterone treatment, the results such as the treatment of invalid operation: 1 cases of treatment failure, 1 cases of conservative treatment and surgical treatment soon give up, 1 cases were lost, the other 2 cases were followed up for 12 and 23 months, no recurrence.

The treatment group B 32 cases were cured, 3 cases of preoperative radiotherapy, 23 cases with hysterectomy (71.9%), extensive / extensive hysterectomy in 9 cases (28.1%), 6 cases of retained one or both ovaries were (18.8%), pelvic lymph node dissection in 23 cases (71.9%, 2 cases underwent abdominal para aortic lymph node dissection), 6 cases of postoperative radiotherapy (18.8%), 4 cases of chemotherapy (12.5%), progesterone treatment in 14 cases (43.8%). Clinical stage III and stage IV were treated with radiotherapy or chemotherapy plus progestin therapy, and 1 patients with I were diagnosed by.

There was no significant difference between the two groups (P< 0.005) in the A group than those in the B group (P> 0.05).

5, prognosis

52 patients were lost to follow-up, and the other 47 patients were followed up from 1 to 158 months, with an average follow-up of 30 months (SD:30.63). There was no recurrence in A group. B group of 2 cases of recurrence, including 1 cases of postoperative vaginal vault 3 years local recurrence, radiotherapy; another 1 cases of low differentiation of clear cell carcinoma (stage IIIa, deep myometrial and cervical stromal invasion), 1 years after surgery of abdominal lymph node recurrence re resection plus chemotherapy plus progesterone. And followed up for 2 years without recurrence.

discuss

1, the incidence and clinical characteristics of young endometrial cancer:

The incidence of endometrial cancer increased with age. The incidence of endometrial carcinoma in our hospital was 12.7% under the age of 45, which was similar to that reported in the literature [1]. Generally, endometrial cancer according to the clinical features and pathogenesis, can be divided into two types: [2], endometrioid carcinoma and non endometrioid carcinoma (plasma breast cancer, clear cell carcinoma, etc.) the former related stimulus and long-term unopposed estrogen can occur in endometrial hyperplasia, with good prognosis. The latter with estrogen and intimal hyperplasia has a poor prognosis. Young patients are the first type, often associated with primary infertility, irregular menstruation, polycystic ovary and endometrial hyperplasia [2,3]. In this study, the incidence of non endometrioid carcinoma was 3.8% in patients under the age of 45, which was lower than the general level of the previous report of 16.5% ([4]). Nearly 50% of young patients with menstrual disorders, infertility and endometrial hyperplasia, especially in patients under the age of 52.9%, in combination with polycystic ovaries, indicating that estrogen plays an important role in the pathogenesis of the group.

2, the prognosis of young endometrial cancer

The prognosis of younger endometrial cancer is better than that of postmenopausal women. Generally, endometrial hyperplasia (more common in young patients with good prognosis [5]), but the multi factor analysis was that the prognostic factors of [6] age and intimal hyperplasia are not independent, the prognosis in young endometrial cancer, related factors and less risk, including these risk factors: non endometrioid carcinoma, low differentiation deep myometrial invasion, lymph vascular space involvement, adnexal metastasis, ascites cytology, lymph node metastasis. The data show that 45 years old and below the risk factors in patients with a ratio of (10/52), especially in patients under the age of 35, almost no risk factors, a good prognosis.

3, treatment should pay attention to the problem:

In view of the above characteristics of young patients with endometrial cancer, the treatment is sometimes different from the elderly patients. For patients with early not birth, can be considered efficient progestogen therapy to preserve fertility, especially when it is difficult to distinguish the pathological endometrial carcinoma and atypical hyperplasia, by pathologists diagnosed with experience, except in not severe atypical hyperplasia, should consider pregnancy hormone therapy, regular examination, observation of curative effect (such as: every 3 months for curettage). There are a lot of reports about the success of progesterone therapy for early endometrial cancer, [3,7], our observation time is short, there is no fertility, but there are 2 cases of remission. In addition, for young patients can keep the ovarian function has been controversial, generally, endometrial cancer is estrogen dependent disease, should undergo ovariectomy, but for younger patients, loss of ovarian function will lead to severe menopausal symptoms, serious impact on the quality of life. In the study group, 35 patients under the age of 71.4% retained one or both ovaries, ovarian preservation showed adverse effects on prognosis seems to be no, so we think, for young patients with no risk factors, is safe and may keep the ovarian function. Because of the limited number of cases in this study, and the results of a retrospective study, the results need to be further confirmed by prospective randomized controlled trials.

Reference

[1] Tran BN, Connell PP, Waggoner S, et Characteristics outcome endometrial carcinoma patients age 45 years younger. J Clin Oncol Oct 2000; (5): 476-80 (and): Am 23 and

[2] Niwa K, Imai A, Hashimoto M, et al. case-control of endometrial cancer pre- and women. Oncol Rep, 2000,7 (1): 89-93. post-menopausal (of) uterine study

[3] Cao ZY. carcinoma young Zhonghua Chan Ke Zhi 1990,25 (2): 73-76123. [Endometrial in (women]) Za Fu

[4] Wu Ming, Shen Keng, Lang Jinghe et al. Clinical analysis of 206 cases of endometrial carcinoma. Chinese Journal of Obstetrics and Gynecology, 2002,37 (10): 620-621.

[5] Kaku T, Tsukamoto N, Hachisuga T al. carcinoma with hyperplasia. Gynecol Oncol, 1996,60 (1): 22-25. ET (associated) Endometrial

[6] Gucer F, Reich O, Tamussino K, et al. endometrial in with endometrial carcinoma. Gynecol Oncol, 1998,69 (1): 64-68. Concomitant (patients)

[7] Kaku T, Yoshikawa H, Tsuda H, et al. Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett 2001167 (1): 39-48.

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Xiamen 100730 people's Hospital, Fujian, China (Chen Qionghua)

 

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