Young patients with endometrial cancer: How many could be eligible for fertility-sparing treatment?
Introduction
Endometrial carcinoma (EC) is the most common gynecologic malignancy in women with a world-standardized incidence in Switzerland of 18.6/100,000 [1]. In Switzerland EC occurs typically in postmenopausal women with a mean age of 67.7 years [2]. Approximately 20% of women will be diagnosed before menopause, and 5% of them will develop the disease before the age of 40 years [3]. The occurrence of EC at a young age has been associated with prolonged unopposed estrogen exposure, for instance in women suffering from hormone-related disorders, obesity, infertility or polycystic ovary syndrome (PCOS) [4], [5], [6].
EC in patients aged less than 45 years may have a more favorable prognosis than in older patients with more frequent well-differentiated tumor and limited myometrial invasion [7], [8], [9]. Therefore, many attempts have been made to treat these women conservatively with medical fertility-sparing therapy using progestin. Several publications based on small numbers of patients have reported encouraging results [10], [11], [12], [13], [14]. However, conservative treatment entails the risk of progression. Recently, adverse outcomes in conservatively managed patients have been reported [15]. Also, several studies have pointed out that EC among young patients is not more indolent than in older and presents a higher risk of synchronous malignancies [16], [17], [18].
The aims of our study were to compare tumor characteristics and prognosis between women with EC aged 45 years old or less and older women, and estimate how many patients may potentially be eligible for fertility preservation at the time of diagnosis.
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Materials and methods
We used information from the population-based Geneva Cancer Registry to identify all patients with a diagnosis of EC in the canton of Geneva (approximately 435,000 inhabitants) from 1970 to 2005. Patient information is derived from numerous sources: all university and private pathology laboratories, hospitals, private clinics, and private practitioners, and is considered exhaustive, as attested by the low percentage (< 2%) of patient cases recorded from death certificates only [19].
Recorded
Results
A total of 1365 patients were included in the analysis. The young group comprised 44 patients (3.2%), and the old group 1321 patients (96.8%). For the young group, mean age at diagnosis was 39.8 (± standard deviation (SD) 4.2) years and for the old group 67.3 (± SD10.7) years. Incidence of EC was similar in the two groups during the study period.
The clinical characteristics of the young group are presented in Table 1. BMI was available for 14 patients and revealed a mean BMI of 29.2 kg/m2 (range
Discussion
Standard therapy for EC stage I is surgical staging including total hysterectomy, bilateral salpingo-oophorectomy peritoneal cytology with or without retroperitoneal lymph node dissection. Young patients with EC have generally a good prognosis and tend to have disorders related to exposure of excessive estrogen levels. They develop well-differentiated type I EC that can regress with the use of progestin therapy. A fertility-sparing therapy may be proposed in a well-selected group of women who
Conflict of interest statement
The authors declare that there are no conflicts of interest.
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