Background and Objectives: This retrospective study aimed to identify the main comorbidities found in gynecological patients hospitalized for endometrial lesions and to analyze the relationships between these comorbidities and each type of endometrial lesion. The Charlson comorbidity index (CCI) was calculated, thus assessing the patient’s probability of survival in relation to the underlying disease and the existing comorbidities. Materials and Methods: During 2015–2019, 594 cases hospitalized for vaginal bleeding outside of pregnancy were included in the research. For all cases, the frequency of comorbidities was calculated, applying the Cox proportional hazard model, considering the hospitalizations (from the following year after the first outpatient or hospital assessment) as a dependent variable; age and comorbidities were considered as independent variables. Results: Analysis of variance (ANOVA) for mean age of patients enrolled after diagnosis and multiple comparisons (via the Tukey post-hoc test) indicate significant differences (p < 0.05) between the average age for endometrial cancer (EC) and that for the typical endometrial hyperplasia or other diagnoses. The most common comorbidities were hypertension (62.28%), obesity (35.01%), and diabetes (22.89%), followed by cardiovascular disease. An intensely negative correlation (r = −0.715281634) was obtained between the percentage values of comorbidities present in EC and other endometrial lesions. The lowest chances of survival were calculated for 88 (14.81% of the total) patients over 50 years (the probability of survival in the next 10 years being between 0 and 21%). The chances of survival at 10 years are moderately negatively correlated with age (sample size = 594, r = −0.6706, p < 0.0001, 95% confidence interval (CI) for r having values from −0.7126 to −0.6238) and strongly negatively correlated with the CCI (r = −0.9359, p < 0.0001, 95% CI for r being in the range −0.9452 to −0.9251). Conclusions: Using CCI in endometrial lesions is necessary to compare the estimated risk of EC mortality with other medical conditions.
In the early differential diagnosis of endometrial cancer (EC), decisive and mandatory histological aspects are considered, in addition to obvious clinical manifestations. In addition, sonographic aspects are characteristic in relation to the stage, degree, and histological types of identified cancer. This bi-center retrospective observational study included 594 women with abnormal uterine bleeding outside pregnancy, for which a biopsy was performed in the Obstetrics and Gynecology Departments of the Emergency County Hospitals of Arad and Timis Counties, Romania, between 2015 and 2019. Most of the cases were represented by EC or endometrial hyperplasia (EH). Of the 594 cases, 25.5% (n = 153) were EC at women aged between 41 and 85 years. High International Endometrial Tumor Analysis (IETA) scores (3, 4) were associated with a relative risk of 2.9335 compared with other endometrial lesions (95% CI 2.3046 to 3.734, P < 0.0001, NNT 1.805). Histological aspects and pelvic ultrasound using IETA scores represent valuable noninvasive assets in diagnosing and differentiating endometrial cancer from benign uterine pathology.
Endometrial cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial cancer is discovered early, removing the uterus surgically often cures endometrial cancer. The study included all patients who had been evaluated for vaginal bleeding in Obstetrics and Gynecology Department of Clinical Emergency County Hospital, Timisoara between 2016-2018. Of the 195 cases of uterus scraping, 19 cases were labelled as malignant endometrial pathology. For the statistical analysis we calculated some descriptive statistics for the age parameter and the BMI (body mass index) parameter in our disease sample and we compared the BMI values to the BMI values from the control sample As well, we tested to see if there is an association between the Ki-67 values and the HER-2 / neu status in patients with or without endometrial carcinoma. In order to test the significance we applied a Mann -Whitney test, for a = 0.05 set as a confidence level. Unfortunately, in the case of our study group, type 1 endometrial cancers are found in only 5 cases, unlike other countries where most of endometrial cancers are diagnosed early (80% in the first stage) and the 5-year survival rate is about 95%. In any case, the 5-year survival rate is much lower if there is involvement of regional lymph nodes or distant metastasis (68% and 17%, respectively) - as in our case where all cases were classified as Stage III and IV. By running the statistical test we obtained extremely significant differences in the BMI of our patients (p[0.001), the diseased patients tend to have higher BMI values. As well, when we tested the possible association between the Ki-67 values and the HER-2 / neu status in our two groups (patients with or without endometrial carcinoma) we obtained extremely significant differences (p[0.001). The Ki-67 values are increasing proportionally with the carcinoma staging. An endometrial biopsy is the most commonly used test for endometrial cancer and is very accurate in postmenopausal women.
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