Kamarudin, Mohd Irwan
(2016)
Endometrial carcinoma review : a 10-year Hospital Universiti Sains Malaysia experience (January 2002-December 2011).
Masters thesis, Universiti Sains Malaysia.
Abstract
Objective:
This study was conducted to determine the prevalence, and to evaluate the response of
all treatment modalities, and to determine the incidence of recurrence, and to determine the
survival rate of endometrial carcinoma cases that was managed in Hospital University Sains
Malaysia from January 2002 until December 2011.
Methodology:
This is a retrospective study, which conducted by reviewing the patients‟ medical
records with diagnosis of “endometrial cancer, endometrial carcinoma, or uterine cancer”.
Relevant information was obtained, recorded then analysed using descriptive statistics. The
one sample t test was used to determine the significant mean for some of the associated
factors. For survival analysis, simple univariate and multivariate Cox regression model was
used.
Results:
A total of 56 cases were included in this study. Majority of the patients were Malays
(89.3%), and Chinese (8.9%). The factors that associated incidence of endometrial carcinoma
were postmenopausal age with peak incidence was in age group of 50-55 years, mean age
54.3 years (SD 11.77, p = 0.036), nulliparity and low parity (mean 2.75, SD 2.63, p = <
0.001), increase body mass index (BMI) with mean BMI 27.2 kg/m2 (SD 5.43, p = 0.003) and
those with underlying hypertension (53.6%) and diabetes mellitus (21.4%). Almost all
patients were symptomatic at time of presentation (96.4%) with the main presenting
symptoms of per vaginal bleeding in 91.1% and abdominal pain in 19.6% of patients.
However, majority of the patients (55.4%) did not have any remarkable physical finding when
they presented. For the rest of them, the commonest physical finding was the presence of
abdominal mass (39.3%). Ultrasound was the main imaging modality. The main sonographic
features of patients with endometrial carcinoma were abnormal thickened endometrium equal
or greater than 5 mm (85.7%) which were common in the postmenopausal patients (46.4%)
and enlarged uterus (48.2%). The preferred first line of diagnostic test was pipelle sampling
(42.9%), followed by hysteroscopic tissue biopsy (28.6%). When the disease was staged,
majority of patient were in stage I (67.9%). For other stages, 8.9% of patients were in stage II,
19.7% were in stage III and 3.6% in stage IV. The commonest histological type was the
endometrioid adenocarcinoma with its subtypes (87.5%). The other types of histology were
less common, with serous cell type in 3.6% of cases, clear cell type in 3.6%, mixed
adenocarcinoma in 3.6% of cases and undifferentiated type in 1.8%. With regards to
histological grades, many tumours were grade 1 (41.1%) and grade 2 (39.3%) and only 19.6%
were grade 3 tumours. The predominant histological type of tumours with grade 1 and grade 2
were endometrioid adenocarcinoma, whereas for the grade 3 tumours were usually the other
carcinoma subtype (serous cell, clear cell, mixed adenocarcinoma, and undifferentiated). Theendometrioid adenocarcinoma types of tumours were commonly occurred in early stages and
in patient at age below 60. From the aspect of treatment, all patients had undergone surgery
through the course of treatment. For modalities of treatments, majority had surgery followed
with adjuvant radiotherapy (46.4%), while other 39.3% of patients had undergone surgery
only. For the types of surgery, the type of surgery performed on most number of patients was
extrafacial hysterectomy and bilateral salphingo-oopherectomy (BSO) (46.4%), followed by
simple hysterectomy and BSO (41.1%). Despite appropriate treatment, a small number of the
patients still developed recurrence, and later death. 75.0% of patients were disease free after
24 months, while the rest of 25.0% developed recurrence within less than 24 months, with the
most of the patients (12.5%) developed persistence disease within less than 6 months
following treatment. 80.4% of patients were still alive after 24 months following treatment,
while other 19.6% of patients died in less than 24 months, with the most death (12.5%)
occurred in less than 6 months. The significant prognostic factor were stage (stage III, p =
0.003, adjusted HR 26.243) and histological tumour grade (p = 0.015, adjusted HR 10.887).
The 2-years survival rate was 97.4% for stage I, 60.0% for stage II, 36.4% for stage III, and
50.0% for stage IV.
Conclusions:
Despite the inability to come up with survival rate of 5 years due to limitation of the
study, the survival rates at 2 years had managed to show the strong prognostic influence of
stage and grade.
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