Absolute Risk of Endometrial Carcinoma During 20-Year Follow-Up Among Women With Endometrial Hyperplasia

Abstract

PURPOSE The severity of endometrial hyperplasia (EH)-simple (SH), complex (CH), or atypical (AH)-influences clinical management, but valid estimates of absolute risk of clinical progression to carcinoma are lacking. Materials and METHODS We conducted a case-control study nested in a cohort of 7,947 women diagnosed with EH (1970-2002) at one prepaid health plan who remained at risk for at least 1 year. Patient cases (N = 138) were diagnosed with carcinoma, on average, 6 years later (range, 1 to 24 years). Patient controls (N = 241) were matched to patient cases on age at EH, date of EH, and duration of follow-up, and they were counter-matched to patient cases on EH severity. After we independently reviewed original slides and medical records of patient controls and patient cases, we combined progression relative risks (AH v SH, CH, or disordered proliferative endometrium [ie, equivocal EH]) from the case-control analysis with clinical censoring information (ie, hysterectomy, death, or left the health plan) on all cohort members to estimate interval-specific (ie, 1 to 4, 5 to 9, and 10 to 19 years) and cumulative (ie, through 4, 9, and 19 years) progression risks. Results For nonatypical EH, cumulative progression risk increased from 1.2% (95% CI, 0.6% to 1.9%) through 4 years to 1.9% (95% CI, 1.2% to 2.6%) through 9 years to 4.6% (95% CI, 3.3% to 5.8%) through 19 years after EH diagnosis. For AH, cumulative risk increased from 8.2% (95% CI, 1.3% to 14.6%) through 4 years to 12.4% (95% CI, 3.0% to 20.8%) through 9 years to 27.5% (95% CI, 8.6% to 42.5%) through 19 years after AH. CONCLUSION Cumulative 20-year progression risk among women who remain at risk for at least 1 year is less than 5% for nonatypical EH but is 28% for AH.

Evaluation of Endometrial Precancerous Lesions in Postmenopausal Obese Women - A High Risk Group?

“…The time course from a diagnosis of endometrial hyperplasia to carcinoma is not well known. A case control study reported that the average time to diagnosis of cancer was six years in women with all types of EH (Lacey et al, 2010).…”

“…Patients with PMB and endometrial polyps usually undergo endometrial sampling and the removal of polyps because foci of atypical hyperplasia or carcinoma may be present at histopathology in a benign-seeming polyp, or endometrial polyps and carcinoma may coexist in the same patient (Dubinsky et al, 1995;Lacey et al, 2010).…”

Current Issues in the Diagnosis and Treatment of Endometrial Carcinoma

“…endometrial intraepithelial neoplasia [EIN]) shows many of the molecular genetic changes of invasive carcinoma, yet only the presence of atypia is associated with a definite increase in carcinoma risk (l " Table 3) [15]. The expected rate of carcinoma development within 10 years is about 30 % [16]. When considering the risk of progression to invasive carcinoma it should be taken into account that invasive carcinomas are found in up to 48% of hysterectomy samples in this setting [17,18].…”

“…In addition, one study found that atypical hyperplasia was reclassified as invasive carcinoma on second pathological assessment in 29 % of cases [17]. In contrast, the development of invasive carcinoma was very seldom in cases of hyperplasia without atypia (< 5 %) [16]. The following treatment recommendations can be deduced: Hyperplasia without atypia can be treated conservatively.…”

The expression and prognostic significance of the tumour-associated glycoprotein 72 in the normal, hyperplastic and neoplastic endometrium using immunohistochemical methods

“…Recent studies have revealed that less than 5% of simple and complex non-atypical hyperplasia cases undergo malignant transformation in the long term (20 years), whereas this percentage increases to 30% when there is an atypical hyperplasia [5,6].…”