Synchronous primary cancers of the endometrium and ovary in young women: A Korean Gynecologic Oncology Group Study
Introduction
It is estimated that anywhere from 3 to 14% of women with endometrial cancer are younger than 40 years of age and > 70% of them are nulliparous at the time of diagnosis [1], [2]. In most cases, endometrial cancer in these young women presents itself as a well-differentiated endometrioid adenocarcinoma with infrequent myometrial invasion or lymph node metastasis and with a favorable prognosis [3], [4]. The conservative hormonal treatment in young women who desire to preserve their potential for fertility has become as a safe and effective option by a number of groups [5], [6], [7], [8], [9], [10].
Some authors have advocated the use of diagnostic laparoscopy to rule out the presence of coexisting ovarian malignancy as a pretreatment assessment step for conservative treatment of patients with early stage endometrial cancer [11], [12]. Their opinions were based on studies that reported a higher incidence of synchronous ovarian cancer in the range of 11 to 29% in this young subset of women who may be considering uterine and ovarian preservation [2], [12], [13], [14], [15], [16].
However, we had a different opinion through our clinical experiences; although young women with endometrial cancer had a higher incidence of synchronous primary ovarian cancer than old women, the incidence was not as high as those of previous reports. In particular, young women with low-risk early stage endometrial cancer who were candidates for conservative hormonal treatment for on pretreatment assessment (pathological diagnosis of endometrioid adenocarcinoma with grade 1 differentiation; no myometrial invasion or extrauterine spread on the imaging study; normal CA-125 level) seemed to have a remarkably low incidence of synchronous ovarian cancer. To answer these questions, the Korean Gynecologic Oncology Group (KGOG) undertook a multicenter, retrospective study to determine the incidence of synchronous ovarian malignancies in young women with endometrial cancer and to identify characteristics for this group that might be of help with clinical decision-making.
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Materials and methods
From January 1995 to December 2010, 3240 patients with endometrial cancer drawn from seven participating institutions (Asan Medical Center, Seoul, Korea; CHA Gangnam Medical Center, Seoul, Korea; National Cancer Center, Goyang, Korea; Samsung Medical Center, Seoul, Korea; Seoul National University Hospital, Seoul, Korea; Seoul National University Boramae Hospital, Seoul, Korea; Seoul St. Mary's Hospital, Seoul, Korea) were screened for enrollment after obtaining approval from the institutional
Incidence of the synchronous ovarian cancer
Although 3240 patients with endometrial cancer were screened for this study, 3117 patients were excluded due to various reasons (no ovarian malignancy; endometrial cancer with metastasis to the ovary) (Fig. 1). Of 123 patients with synchronous cancer of the endometrium and ovary, 102 patients aged 40 or over were also excluded. The remaining 21 patients composed the study population. Therefore, the incidence of synchronous ovarian malignancies in young women under 40 years of age with
Discussion
The main finding of this study is that the incidence of synchronous ovarian malignancies in young women with endometrial cancer is 4.5%. In particular, if a patient had low-risk early stage endometrial cancer on pretreatment assessment (no myometrial invasion; normal or benign-looking ovaries; normal CA-125; grade 1 endometrioid histology), the potential of synchronous ovarian cancer is extremely rare (0%). The results of this study support our hypothesis that diagnostic laparoscopy to confirm
Conflict of interest statement
The authors declare no competing interest.
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