Risk factors of endometrial cancer in patients with endometrial hyperplasia: implication for clinical treatments

Abstract Background Endometrial hyperplasia (EH) is commonly-seen in the patients with endometrial cancer (EC), we aimed to evaluated the risk factors of EC in patients with EH, to provide evidence to the clinical prevention and treatment of EC. Methods This study was a retrospective study design. EH patients confirmed by pathological examinations and treated with hysterectomy in our hospital from June 1, 2018 to February 28, 2021 were included. The clinical characteristics of EC and no-EC patients were compared and analyzed. Logistics regression analyses were conducted to evaluate the risk factors of EC in patients with EH. Results A total of 228 EH patients were included, the incidence of EC in the EH patients was 31.58%. There were significant differences in the age, BMI, diabetes, hypertension and pathology of EH between EC and no EC groups (all P < 0.05), no significant differences in the hyperlipidemia, preoperative CA125, number of deliveries, menopause and endometrial thickness between EC and no EC groups were found (all P > 0.05). Logistic regression analyses indicated that age > 50 y (OR 3.064, 95% CI 1.945–5.931), BMI ≥ 25 kg/m2 (OR 2.705, 95% CI 1.121–3.889), diabetes (OR 3.049, 95% CI 1.781–5.114), hypertension (OR 2.725, 95% CI 1.108–3.431) and severe hyperplasia (OR 3.181, 95% CI 1.496–4.228) were the risk factors of EC in patients with EH (all P < 0.05). Conclusions The risk of EC in EH patients is high, especially for those patients with age > 50 y, BMI ≥ 25 kg/m2, diabetes, hypertension and severe hyperplasia, special attentions should be paid for occurrence of EC and early diagnosis and early treatment are needed for those patients.

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Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems

Diagnostics ◽

10.3390/diagnostics11030442 ◽

2021 ◽

Vol 11 (3) ◽

pp. 442

Author(s):

Norbert Stachowicz ◽

Agata Smoleń ◽

Michał Ciebiera ◽

Tomasz Łoziński ◽

Paweł Poziemski ◽

...

Keyword(s):

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Menopausal Status ◽

Power Doppler ◽

Uterine Cavity ◽

Abnormal Uterine Bleeding ◽

Scoring Systems ◽

Diagnostic Challenge

Background: Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. Aim: The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. Material and methods: It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. Results: The median age was 60.3 years (range ±10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71–0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65–0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70–0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73–0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. Conclusions: New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.

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Assessment of Risk Scoring Model for Prediction of Endometrial Cancer Among Symptomatic Postmenopausal Women (A Prospective Cohort Study)

QJM ◽

10.1093/qjmed/hcab115.011 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Magdy M Abd Elgawaad ◽

Amr M El Helaly ◽

Malames M Faisal ◽

Asmaa F Kasem

Keyword(s):

Endometrial Cancer ◽

Family History ◽

Endometrial Carcinoma ◽

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

Serous Carcinoma ◽

Scoring Model ◽

Gynecological Malignancy ◽

Risk Scoring ◽

Study Population

Abstract Background Endometrial carcinoma is the most common gynecological malignancy in the developed countries and the third common gynecological malignancy in Egypt after breast and ovarian cancers. Aim of the Work to evaluate this risk scoring model on Egyptian patients and to study the effect of adding other patient characteristics (DM, BMI and relevant family history) on the sensitivity and specificity of RHEA scoring model. Patients and Methods The current study was conducted in Ain Shams University Maternity Hospital in the period between September 2017 and December 2018. A total of 100 women with postmenopausal bleeding and endometrial thickness > 4mm were included in the study. Results Histological examination revealed that benign pathology (n = 65) (73%) was found to be: most common cause was endometrial hyperplasia without atypia (20.3%) followed by chronic endometritis (13.5%), then endometrial polyp (11.3%), cystic atrophy of endometrium (8.9%), proliferative endometrium (8.9%), endometrial hyperplasia with atypia (6.7%) and lastly mucous polyp (3.4%) while malignant histopathology(n = 24)(27%) which is significantly higher than the international rates showed: Endometriod adenocarcinoma (n = 19)(21.3%), papillary serous carcinoma (n = 4)(4.5%) and undifferentiated carcinoma (n = 1)(1.1%). The current study showed that RHEA score performs in our study population with a comparable validity to that reported by its inventors with sensitivity 79.2% (57.8% - 92.9%) vs. 87.5% and specificity 84.6% (73.5% - 92.4%) vs. 80.1% respectively. In results of the current study it was found that the time since onset of menopause rather than age was associated with endometrial cancer with the optimum cut-off for postmenopausal duration was estimated to be 9 years achieving a sensitivity of 87.5% and a specificity of 60.0%, but it needs multivariate analysis on larger and more representative sample size to confirm this association, A statistically significant regression model was including only postmenopausal duration, recurrent bleeding and endometrial thickness. None of age, BMI, family history or hypertension proved a statistically significant predictive effect after adjustment for other predictive variables. Conclusion Taking in consideration the higher prevalence of endometrial carcinoma in the sample of the current study, the wide 95% confidence intervals for the different validity indices for the RHEA scores derived from this study, it seems that RHEA score performs in this study population with a comparable validity to that reported by its inventors.

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Risk factors for suicide attempts in patients with bipolar disorder misdiagnosed with major depressive disorder: results from a national survey in China

10.21203/rs.3.rs-16989/v1 ◽

2020 ◽

Author(s):

Lin Chen ◽

Yu-Yu Xu ◽

Jing-Ge Du ◽

Li-Min Xin ◽

Su-Li Wang ◽

...

Keyword(s):

Risk Factors ◽

Bipolar Disorder ◽

Suicidal Ideation ◽

Clinical Characteristics ◽

Suicide Attempts ◽

Multiple Logistic Regression ◽

Regression Analyses ◽

Major Depressive ◽

Suicide Attempters ◽

Depressive Episodes

Abstract Background: Bipolar disorder (BD) is a kind of mental disorder with the greatest risk of suicide, but it is often misdiagnosed as major depressive disorder (MDD) clinically. This study aimed to analyze the sociodemographic factors and clinical characteristics associated with suicide attempts (SA) in patients with BD misdiagnosed with MDD in China. Methods: A total of 1487 MDD patients were consecutively enrolled in 13 mental health centers in China. Data on patients’ sociodemographic and clinical characteristics were collected using a standardized protocol. Of these, 306 BD patients were misdiagnosed with MDD according to the Mini International Neuropsychiatric Interview (MINI). Suicide attempters and non-attempters were classified by the suicidality module of the MINI. Multiple logistic regression analyses were performed to assess the association between the independent variables of interest and SA in BD patients misdiagnosed with MDD. Results: Of the 306 BD patients misdiagnosed with MDD, 225 (73.5%) were non-attempters and 81 (26.5%) were attempters. Compared to non-attempters, attempters were older (Z =2.2, p = 0.03) and had more admissions(χ2 =6.1, p = 0.013), more frequent depressive episodes, more atypical characteristics (e.g. increased appetite, weight gain, and more sleep time)(χ2 = 5.8, p = 0.016), more suicidal ideation (χ2 = 27.3, p < 0.001), more psychotic symptoms (χ2 = 7.4, p = 0.006) and more seasonal depressive episodes (χ2 = 5.6, p = 0.018). Multiple logistic regression analyses revealed that attempters were characterized by more suicidal ideation (OR = 5.7, 95% CI: 2.6–12.5) and frequent depressive episodes (OR = 2.4, 95% CI: 1.3–4.6). The limitations of this study include its cross-sectional design and data collection by suicide attempters’ retrospective recall. Conclusions: The findings of this study suggest that BD patients misdiagnosed with MDD are at a higher risk of suicide, and more frequent depressive episodes and suicidal ideation are risk factors for attempted suicide. Early identification of and interventions for these risk factors might reduce the risk of suicide in BD patients misdiagnosed with MDD.

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Risk factors and sonographic endometrial thickness as predictors of tumour stage and histological subtype of endometrial cancer

Gynecologic Oncology Reports ◽

10.1016/j.gore.2019.100491 ◽

2019 ◽

Vol 30 ◽

pp. 100491

Author(s):

Ivana Rizzuto ◽

Rachel Nicholson ◽

Wendy S. MacNab ◽

Mythili Nalam ◽

Rohit Sharma ◽

...

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Endometrial Thickness ◽

Histological Subtype ◽

Tumour Stage

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Clinical study of risk factors and ultrasonographic correlation of endometrial hyperplasia according to the WHO classification 2014

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205235 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4989

Author(s):

Janu Mangala Kanthi ◽

Sudha Sumathy ◽

Anu Vasudevan ◽

Gokulkumar Kamalanathandurai

Keyword(s):

Risk Factors ◽

Endometrial Hyperplasia ◽

Who Classification ◽

Endometrial Thickness ◽

Color Doppler ◽

Significant Risk ◽

Atypical Hyperplasia ◽

Obese Women ◽

Obesity And Diabetes ◽

Significant Difference

Background: Type 1 endometrial carcinoma is usually preceded by atypical hyperplasia. Nonatypical hyperplasia should be managed conservatively and atypical hyperplasia have to be managed aggressively. So, the diagnosis is crucial for its management.Methods: The study population included women diagnosed with endometrial hyperplasia by histopathology as per WHO classification 2014 from the year January 2015 to February 2020.Women with endometrial polyp diagnosed by transvaginal ultrasonography and histopathology were excluded. Primary objective was to compare the endometrial thickness between the two types of hyperplasia. Secondary objective was to analyses the risk factors of the two types.Results: In multivariate analysis of logistic regression, diabetic women have 1.57 times risk of developing atypia and obese women have 3.12 times risk of developing atypia. Polycystic ovarian disease is having borderline significance for causing atypia. There was significant difference in endometrial thickness between atypical and nonatypical hyperplasia (P=0.040). In premenopausal women, (P=0.069) the thickness difference in atypia is of only borderline significance. Heteroechoic pattern or cystic spaces in the endometrium also didn’t predict atypia.Conclusions: Mean endometrial thickness is significantly different in atypical hyperplasia. Heteroechoic pattern of endometrium do not predict atypia. We need color doppler sonography to gain knowledge about atypia. Obesity and diabetes mellitus are significant risk factors of atypia.

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Risk factors of progression to endometrial cancer in women with endometrial hyperplasia: A retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0243064 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243064

Author(s):

Jin Young Jeong ◽

Sung Ook Hwang ◽

Banghyun Lee ◽

Kidong Kim ◽

Yong Beom Kim ◽

...

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Retrospective Cohort ◽

Selection Criteria ◽

Endometrial Hyperplasia ◽

Protective Factor ◽

Claim Data ◽

Atypical Endometrial Hyperplasia ◽

Diagnostic Codes

Objective This study aimed to investigate risk factors of progression to endometrial cancer (EC) in women with non-atypical and atypical endometrial hyperplasia (EH). Methods The data of 62,333 women with EH diagnostic codes from 2007 to 2018 were sourced from the Korean Health Insurance Review and Assessment Service databases. The data from 11,525 women with non-atypical EH and 2,219 women with atypical EH who met the selection criteria were extracted for analysis. Results Risk of EC in women with EH decreased in 40–49 year olds compared to other ages (non-atypical EH: [≤39 vs. 40–49 years] HR, 0.557; 95% CI, 0.439–0.708; P<0.001; [≤39 vs. ≥50 years] P = 0.739; atypical EH: [≤39 vs. 40–49 years] HR, 0.391; 95% CI, 0.229–0.670; P = 0.001; [≤39 vs. ≥50 years] P = 0.712). Risk of EC increased with increase in number of follow-up biopsies in women with non-atypical EH (1 biopsy: HR, 1.835; 95% CI, 1.282–2.629; P = 0.001; ≥2 biopsies: HR, 3.644; 95% CI, 2.585–5.317; P<0.001) and in women receiving ≥2 follow-up biopsies with atypical EH (HR, 3.827; 95% CI, 1.924–7.612; P = 0.001). Time of progression to EC decreased in women ≥50 years old with non-atypical EH compared to other ages (P = 0.004) and showed no differences among ages in women with atypical EH (P = 0.576). Progestational agents were a protective factor for EC in women with non-atypical EH (HR, 0.703; 95% CI, 0.565–0.876; P = 0.002). Conclusions In this claim data analysis, women ≤39 and ≥50 years old with EH were at a high risk for progression to EC, and repeat follow-up biopsy after a diagnosis of EH increased detection of EC. Progestational agents were an effective modality to prevent EC in women with non-atypical EH.

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Endometrial hyperplasia: without atypia and with atypia

GYNECOLOGY ◽

10.26442/20795696.2021.1.200666 ◽

2021 ◽

Vol 23 (1) ◽

pp. 18-24

Author(s):

Maksim A. Sabantsev ◽

Svetlana V. Shramko ◽

Vladimir G. Levchenko ◽

Oleg A. Volkov ◽

Tatyana V. Tretyakova

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Hormone Therapy ◽

Research Methods ◽

Endometrial Hyperplasia ◽

Menopausal Hormone Therapy ◽

Pubmed Database ◽

Gynecological Diseases ◽

Current Classification

The article analyzes and presents data for the last 70 years from the PubMed database on endometrial hyperplasia (EH), which is one of the leaders in the structure of gynecological diseases and the main predictor of endometrial cancer (EC). The chronicle of the EH classification is highlighted with a focus on changing the designation and relevance of adenomatous EH. It is shown how the current classification of EH, due to the fact that a large number of synonyms is limited by two options, allows to maximize the reproducibility of the diagnosis, improve the interaction of the obstetrician-gynecologist with the pathologist and reduce the treatment inefficiency. The results of modern studies on the prevalence and risk factors of EH and EC differ from previously accepted ones and destroy the Bohman triad. The risks of EH development with tamoxifen and menopausal hormone therapy are determined. The data of current research methods aimed at the diagnosis of EH and EC are indicated. The differences in etiopathogenesis, prevalence, diagnosis, risk factors for development and progression to the malignant process presented in the review represent two types of EH (without atypia and with atypia) as completely different endometrial diseases included in the same classification.

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Endometrial hyperplasia, endometrial cancer and prevention: Gaps in existing research of modifiable risk factors

European Journal of Cancer ◽

10.1016/j.ejca.2008.05.001 ◽

2008 ◽

Vol 44 (12) ◽

pp. 1632-1644 ◽

Cited By ~ 44

Author(s):

Faina Linkov ◽

Robert Edwards ◽

Judith Balk ◽

Zoya Yurkovetsky ◽

Barbara Stadterman ◽

...

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Modifiable Risk Factors

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Insulin Resistance and Metabolic Syndrome Increase the Risk of Relapse For Fertility Preserving Treatment in Atypical Endometrial Hyperplasia and Early Endometrial Cancer Patients

Frontiers in Oncology ◽

10.3389/fonc.2021.744689 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xingchen Li ◽

Yuan Fan ◽

Jiaqi Wang ◽

Rong Zhou ◽

Li Tian ◽

...

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Metabolic Syndrome ◽

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Univariate Analysis ◽

Roc Curves ◽

Atypical Endometrial Hyperplasia ◽

Fertility Sparing ◽

Risk Factors For Recurrence

ObjectiveFertility-sparing treatment for young women with atypical endometrial hyperplasia (AEH) and early endometrial cancer (EC) is a difficult challenge. Insulin resistance (IR) and metabolic syndrome (MetS) are two potentially crucial, but currently enigmatic factors in the recurrence of AEH and early EC patients. In this study we attempt to elucidate these factors.MethodsA retrospective study was conducted from January 2010 to December 2019. Risk factors for recurrence and complete remission time after recurrence (RCR time) were investigated. ROC curves were built to estimate the accuracy of the metabolic characteristics and Kaplan–Meier (K–M) analysis was used to calculate recurrence-free survival (RFS) for patients with various IR or MetS statuses.ResultsA total of 111 AEH or early EC patients met the criteria and were enrolled in our study. Univariate analysis found that BMI ≥25 kg/m2 (OR = 2.7, 95% CI: 1.1–6.4, P = 0.03), IR (OR = 9.5, 95% CI: 3.3–27.0, P <0.001), MetS (OR = 4.9, 95% CI:1.5–15.5, P = 0.008), IR+ and MetS+ (OR = 21.0, 95% CI: 4.8–92.7, P <0.001), histological type (OR = 3.5, 95% CI: 1.5–7.9, P = 0.003), and maintenance treatment (OR = 0.3, 95% CI: 0.1–0.6, P = 0.005) were all significantly associated with recurrence and longer RCR time. Among these factors, IR and MetS were determined to be two independent risk factors for recurrence. Moreover, using IR and MetS as markers significantly improved the diagnostic accuracy of recurrence for fertility-sparing treatment patients (AUC = 0.818, P <0.05) and may play synergistic roles in suppressing treatment. K–M analysis indicated both metabolic features played important roles in RFS (P <0.05).ConclusionBoth IR and MetS were significantly associated with recurrence and longer RCR time in AEH and early EC patients receiving fertility-sparing treatment.

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The risk of endometrial (pre)malignancy in women having postmenopausal uterine bleeding at Tu Du Hospital

MedPharmRes ◽

10.32895/ump.mpr.5.3.4 ◽

2021 ◽

Vol 5 (3) ◽

pp. 21-26

Author(s):

Hoa Hong Nguyen ◽

Loan Ha ◽

Nguyen Ngoc Tran ◽

Thien Minh Trinh

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Credible Interval ◽

Cross Sectional Study ◽

Uterine Bleeding ◽

Atypical Hyperplasia ◽

Cross Sectional ◽

Case File

Introduction: Endometrial cancer and endometrial atypical hyperplasia, futher referred to as endometrial (pre)malignancy in approximately 8.3-17.6% of cases depending on different studies. The incidence of abnormal endometrium increases during the postmenopausal period, especially endometrial (pre)malignancy. There are limited data regarding endometrial (pre)malignant disorders in patients with postmenopausal uterine bleeding. Purpose: The aim of this study is to investigate the risk of endometrial cancer and atypical hyperplasia in the women who had postmenopausal uterine bleeding (PUB) and assess the risk factors associated with such cases. Methods: A cross-sectional study was conducted on 164 women with PUB used vacuum aspirator with Karman canula to evaluate endometrial pathology, underwent treatment at deparment of Gynaegology, Tu Du hospital through a set of questionaires and case file reports completed from February to June of 2020. Results: In Bayesian inference, the risk of endometrial (pre)malignancy was 17.5%, CI (credible interval) 95% of 14.1 to 21.1%. There was a significant association between the risk and the duration of bleeding (OR = 1.02, CI 95% 1.01 to 1.03, LR+ 1.96, LR- 0.37), number of live births (OR = 0.79, CI 95% 0.66 to 0.95, LR+ 2.41, LR- 0.76), endometrial thickness (OR = 1.08, CI 95% 1.01 to 1.16, LR+ 1.16, LR- 0.77) and the presence of abnormal intracavitary mass in transvaginal ultrasound (OR = 9.12, CI 95% 4.09 to 20.33, LR+ 3.65, LR- 0.4). Conclusions: Using manual vacuum aspirator with Karman canula showed the risk of (pre)malignancy in women having PUB and this risk depends on the presence of the risk factors.

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