Complex Endometrial Hyperplasia: Prevalence and Risk Factors for coexisting Endometrial Carcinoma

Abstract

Objective: This study was planned to observe the prevalence of endometrial carcinoma in patients with complex endometrial hyperplasia. It has also assessed the risk factors for concomitant endometrial carcinoma. Materials and methods:Retrospective analysis of 71 patients with complex endometrial hyperplasia surgically treated between 1995 and 2015 in Aga Khan University Hospital, Karachi, Pakistan, was performed. Results:The prevalence rate of concurrent endometrial carcinoma in patients with endometrial hyperplasia was 34%. The rate for concurrent endometrial carcinoma in patients with complex hyperplasia with atypia was 49% as compared with 4.2% in patients without atypia. Cancer risk was significantly related to menopause (p = 0.043) and presence of atypia (p = 0.0005).Multivariate analysis to adjust for confounders revealed that cytological atypia [odds ratio (OR), 17.12; 95% confidence interval (CI), 2.07-141.42], menopause (OR, 2.07; 95% CI, 0.51-7.91), and hypertension (OR, 1.67; 95% CI, 0.51-5.44) were independent risk factors for endometrial hyperplasia coexisting with endometrial carcinoma Conclusion: The optimal management for menopausal women with complex hyperplasia along with atypia should be surgical intervention. We recommend that these women should be managed in centers where expertise and skills of adequate surgical staging are available.