Endometrial Cancer in Hospital Universiti Sains Malaysia

  • Wan-Nor-Asyikeen, Wan Adnan (Unit of Biostatistics and Research Methodology) ;
  • Siti-Azrin, Ab Hamid (Unit of Biostatistics and Research Methodology) ;
  • Jalil, Nur Asyilla Che (Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia) ;
  • Othman, Nor Hayati (Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia) ;
  • Zain, Anani Aila Mat (Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia)
  • Published : 2016.06.01

Abstract

Background: Endometrial cancer is the most common gynecological malignancy among females worldwide, approximately 320,000 women being diagnosed with the disease each year and 76,000 dying. To date, there is limited knowledge of endometrial cancer in Malaysia. Objectives: To identify the epidemiological profile and prognostic factors of survival. Materials and Methods: A list of endometrial cancer patients in 2000-2011 was obtained from the hospital Record Department. Only cases confirmed by histopathology examination were included. We excluded those with incomplete medical records or referral cases. Simple and multiple Cox regression approaches were used for data analysis. Results: Only 108 cases were included with a mean (SD) age of 62.7 (12.3) years, with 87.0% Malay ethnicity. Grade of cancer was: 29.1% grade 1, 43.7% grade 2 and 27.2% grade 3. The majority of patients had non-endometrioid type (60.2%), with myometrial invasion (82.2%) and lymphovascular invasion (57.3%). The significant prognostic factors were age (HR 1.05; 95% CI: 1.02, 1.08, p=0.002) and having lymphovascular invasion (HR 2.15; 95% CI: 1.08, 4.29; p=0.030). Conclusions: Endometrial cancer patients should be diagnosed earlier to reduce the risk of mortality. The public should be given education on the signs and symptoms of the disease.

Keywords

Endometrial cancer;mortality;prognostic factors;Malaysia

References

  1. Baird D, Dunson DB (2003). Why is parity protective for uterine fibroids? Epidemiol, 14, 247-50.
  2. Briet JM, Hollema H, Reesink N, et al (2005). Lymphvascular space involvement: an independent prognostic factor in endometrial cancer. Gynecol Oncol, 96, 799-4. https://doi.org/10.1016/j.ygyno.2004.11.033
  3. Brinton LA, Westwoff CL, Scoccia B, et al (2013). Fertility drugs and endometrial cancer risk: results from an extended followup of a large infertility cohort. Hum Reprod, 28, 2813-21. https://doi.org/10.1093/humrep/det323
  4. Dos Reis R, Burzawa JK, Tsunoda AT, et al (2015). Lymphovascular space invasion portends poor prognosis in low-risk endometrial cancer. Int J Gynecol Cancer, 25, 1292-99. https://doi.org/10.1097/IGC.0000000000000490
  5. Dossus L, Allen N, Kaaks R, et al (2010). Reproductive risk factors and endometrial cancer: The European Prospective Investigation into Cancer and Nutrition. Int J Gynecol Cancer, 127, 442-51.
  6. Emons G, Fleckensteins G, Hinney B, Huschmand A, Heyl W (2000). Hormonal interactions in endometrial cancer. Endocr Relat Cancer, 7, 227-42. https://doi.org/10.1677/erc.0.0070227
  7. Fauziah M, Hamizah M, Norazmi A, Lila P (2006). Report no. 1/2006. Kota Bharu: Kelantan Health State Department, 1999-2003.
  8. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-17. https://doi.org/10.1002/ijc.25516
  9. Friberg E, Mantzoros CS, Wolk A (2007). Diabetes and risk of endometrial cancer: a population-based prospective cohort study. Cancer Epidemiol Biomarkers Prev, 16, 276-80. https://doi.org/10.1158/1055-9965.EPI-06-0751
  10. Henderson BE, Feigelson HS (2000). Hormonal carcinogenesis. Carcinogenesis, 21, 427-33. https://doi.org/10.1093/carcin/21.3.427
  11. Jemal A, Bray F, Center MM, Ferlay J, Ward E, et al (2011). Global cancer statistics. CA Cancer J Clin, 69, 69-90.
  12. Jones ME, Van Leeuwen FE, Hoogendoorn WE, et al (2012). Endometrial cancer survival after breast cancer in relation to tamoxifen treatment: pooled results from three countries. Breast Cancer Res, 14, 91. https://doi.org/10.1186/bcr3206
  13. Karageorgi S, Hankinson SE, Kraft P, De Vivo I (2010). Reproductive factors and postmenopausal hormone use in relation to endometrial cancer risk in the Nurses' Health Study cohort 1976-2004. Int J Cancer, 126, 208-16. https://doi.org/10.1002/ijc.24672
  14. Kashima H, Shiozawa T, Miyamoto T, et al (2009). Autocrine stimulation of IGF1 in estrogen-induced growth of endometrial carcinoma cells: involvement of the mitogenactivated protein kinase pathway followed by up-regulation of cyclin D1 and cyclin E. Endocr Relat Cancer, 16, 113-22.
  15. Kaupilla A, Gronroos M, Nieminen U (1982). Clinical outcome in endometrial cancer. Obstet Gynecol, 60, 473-80.
  16. Lindemann K, Vatten LJ, Ellstrom-Engh M, Eskild A (2008). Body mass, diabetes and smoking, and endometrial cancer risk: a follow-up study. Br J Cancer, 98, 1582-85. https://doi.org/10.1038/sj.bjc.6604313
  17. Lopez-Bermejo A, Khosravi J, Fernandez-Real JM, et al (2006). Insulin resistance is associated with increased serum concentration of IGF-binding protein-related protein 1 (IGFBP-rP1/MAC25). Diabetes, 55, 2333-39. https://doi.org/10.2337/db05-1627
  18. Mannelqvist M, Sefanson IM, Bredholt G, et al (2011). Gene expression patterns related to vascular invasion and aggressive features in endometrial cancer. Am J Pathol, 178, 861-71. https://doi.org/10.1016/j.ajpath.2010.10.040
  19. Mendivil A, Schuler KM, Gehrig PA (2009). Non-endometrioid adenocarcinoma of the uterine corpus: a review of selected histological subtypes. Cancer Control, 16, 46-52. https://doi.org/10.1177/107327480901600107
  20. Pavelic J, Radakovic B, Pavelic K (2007). Insulin-like growth factor 2 and its receptors (IGF 1R and IGF 2R/mannose 6-phosphate) in endometrial adenocarcinoma. Gynecol Oncol, 105, 727-35. https://doi.org/10.1016/j.ygyno.2007.02.012
  21. Renehan AG, Zwahlen M, Minder C, et al (2004). Insulin-like growth factor (IGF)-I, IGF binding protein-3, and cancer risk: systematic review and meta-regression analysis. Lancet, 363, 1346-53. https://doi.org/10.1016/S0140-6736(04)16044-3
  22. Schonfeld SJ, Hartge P, Pfeiffer RM, et al (2013). An aggregated analysis of hormonal factors and endometrial cancer risk by parity. Cancer, 119, 1393-99. https://doi.org/10.1002/cncr.27909
  23. Yu H & Rohan T (2000). Role of the insulin-like growth factor family in cancer development and progression. J Natl Cancer Inst, 92, 1472-89. https://doi.org/10.1093/jnci/92.18.1472
  24. Zainal Ariffin O, Nor Saleha I (2011). National Cancer Registry Report 2007. Malaysia: Ministry of Health.
  25. Zaorsky NG, Patil N, Freedman GM, Tuluc M (2012). Differentiating lymphovascular invasion from retraction artifact on histological specimen of breast carcinoma and their implications on prognosis. J Breast Cancer, 15, 478-80. https://doi.org/10.4048/jbc.2012.15.4.478