Malignant Uterine Neoplasms Attended at a Brazilian Regional Hospital: 16-years Profile and Time Elapsed for Diagnosis and Treatment

Abstract

Objective The present study aims to evaluate the profile of endometrial carcinomas and uterine sarcomas attended in a Brazilian cancer center in the period from 2001 to 2016 and to analyze the impact of time elapsed from symptoms to diagnoses or treatment in cancer stage and survival. Methods This observational study with 1,190 cases evaluated the year of diagnosis, age-group, cancer stage and histological type. A subgroup of 185 women with endometrioid histology attended in the period from 2012 to 2017 was selected to assess information about initial symptoms, diagnostic methods, overall survival, and to evaluate the influence of the time elapsed from symptoms to diagnosis and treatment on staging and survival. The statistics used were descriptive, trend test, and the Kaplan-Meier method, with p-values < 0.05 for significance. Results A total of 1,068 (89.7%) carcinomas (77.2% endometrioid and 22.8% non-endometrioid) and 122 (10.3%) sarcomas were analyzed, with an increasing trend in the period (p < 0.05). Histologies of non-endometrioid carcinomas, G3 endometrioid, and carcinosarcomas constituted 30% of the cases. Non-endometrioid carcinomas and sarcomas were more frequently diagnosed in patients over 70 years of age and those on stage IV (p < 0.05). The endometrioid subgroup with 185 women reported 92% of abnormal uterine bleeding and 43% diagnosis after curettage. The average time elapsed between symptoms to diagnosis was 244 days, and between symptoms to treatment was 376 days, all without association with staging (p = 0.976) and survival (p = 0.160). Only 12% of the patients started treatment up to 60 days after diagnosis. Conclusion The number of uterine carcinoma and sarcoma cases increased over the period of 2001 to 2016. Aggressive histology comprised 30% of the patients and, for endometrioid carcinomas, the time elapsed between symptoms and diagnosis or treatment was long, although without association with staging or survival.

Symptomatic women experience long waits for endometrial cancer diagnosis and treatment in Brazil

“…A retrospective cohort study was carried out with a medical records review of 430 patients with uterine neoplasms treated between 2010 and 2018 in a regional cancer center under the Brazilian public health care system ("Sistema Unico de Saude-SUS"). The sample size calculation was based on a previous local study that showed a 75% overall survival rate at five years for endometrioid carcinoma grades 1 or 2 and 48% for endometrioid carcinoma grade 3 [9]. Fixing the Type I error at 5% and 80% of sample power, the required sample was 134 cases per prognostic group.…”

“…First, the cohort with the less prevalent Type II neoplasms (nonendometrioid carcinomas, endometrioid carcinomas G3, and carcinosarcomas) was built. Cases selection started in the date April 2018 and continued backwards until the year 2010, keeping the different histology proportions similar to those previously reported [9] until the required number of cases was reached. The inclusion criteria were applied for all selected Type II cases when their medical records were reviewed: diagnosis confirmed by pathological report, treatment carried out at the institution, and symptomatic cases.…”

“…Flowchart of case selection. First, the cases for the Type II neoplasms were selected retrogradely, from April 2018 to 2010, keeping the different histology proportions similar to those previously reported [9] until the required sample number was reached. Similarly, the cohort with Type I neoplasms was built, also controlling the histological grade proportion.…”

“…In a previous study published by our group in 2021, a detailed profile of 1190 women with malignant uterine neoplasms was reported [9]. The analysis of a subgroup of 185 endometrioid carcinoma cases found that a long time elapsed between the onset of symptoms and starting treatment, averaging 376 days, and 82% of them waited more than 180 days before starting treatment.…”

“…Unexpectedly, the long wait times did not worsen cancer staging or overall survival, although only 12% started treatment within 60 days of symptom onset, the local regulatory time frame [10]. A possible explanation was the relatively low aggressiveness of the endometrioid histology considered [9]. A similar lack of association has already been described for other neoplasms, and recent studies with endometrial carcinomas have focused only on assessing the delay to start treatment, also with controversial results [11][12][13][14].…”