Clinical/pathologic features and patient outcome in early onset endometrial carcinoma: A population based analysis and an institutional perspective from the Detroit metropolitan area, Michigan

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• 作者：Assaad Semaan^a ; ^{asemaan@med.wayne.edu} ; Rouba Ali-Fehmi^b ; ^{rali@med.wayne.edu} ; Adnan R. Munkarah^a ; ^c ; ^{amunkar1@hfhs.org} ; Sudeshna Bandyopadhyay^c ; ^{sbandyop@dmc.org} ; Robert T. Morris^a ; ^{rmorris@med.wayne.edu} ; Sara Rizk^a ; ^{srizk@med.wayne.edu} ; Ismail Mert^a ; ^{imert@med.wayne.edu} ; Julie J. Ruterbusch^d ; ^e ; ^{ruterbusc@med.wayne.edu} ; Michele L. Cote^d ; ^e ; ^{mlcote@med.wayne.edu}
• 关键词：Endometrial cancer ; Race ; Age
• 刊名：Gynecologic Oncology
• 出版年：2012
• 出版时间：February 2012
• 年：2012
• 卷：124
• 期：2
• 页码：265-269
• 全文大小：281 K

文摘

Objective

Analyze tumor characteristics and outcomes in patients with endometrial carcinoma (EC) < 40 years of age and compare them to the characteristics of patients ?#xA0;40 years of age.

Methods

10,700 patients (305 patients < 40 years of age) diagnosed between 1988 and 2007 with EC from the Metropolitan Detroit Cancer Surveillance System (MDCSS), and 884 patients (42 patients < 40 years of age) diagnosed between 1996 and 2008 with EC from our institutional database were identified. Differences in clinical and demographic variables by age (< 40 vs. ?#xA0;40) were assessed for statistical significance by chi-square tests. Cox proportional hazards models were used to calculate adjusted hazard ratios (HR) and their 95 % confidence intervals (95 % CI) to assess the risk of death from all causes.

Results

MDCSS based analysis: Patients < 40 were more likely to present with low grade tumors (p < 0.0001) and endometroid histology (p = 0.0004) but less likely to undergo surgery (p = 0.0007) or radiotherapy (p = 0.0007). A multivariate analysis confirmed the significance of age, grade, and stage in all patients, and that of histologic type, surgery, and race in patients ?#xA0;40 as independent prognostic factors for overall survival. Institution based analysis: Patients < 40 had a higher proportion of patients with BMI ?#xA0;30 (p = 0.04), and presented with a higher frequency of well differentiated (p = 0.04) endometrioid tumors (p = 0.004) that are less prone to have deep myometrial invasion (p = 0.008).

Conclusion

This study supports the hypothesis of a disease that is biologically and genetically heterogeneous among women of different ages and ethnicities.