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Abstract
Introduction/Background Endometrial cancer (EC) primarily affects postmenopausal females, with only 4% of patients being 40 years or younger. Most EC in young females is of low grade (FIGO grades 1 and 2). FIGO grade 3 or high-grade EC (HGEC) is rare in young females and usually have poor prognosis. We aim to highlight the clinicopathological features of EC in young patients, with an emphasis on HGEC characteristics.
Methodology Retrospective data from 75 EC patients aged ≤ 40 in two institutes in USA (2005–2023) were analyzed. Patients aged >40 and lacking surgical staging were excluded. Overall survival (OS) and recurrence-free survival (RFS) were determined using Kaplan-Meier methods for 64 patients. Descriptive analysis and Cox proportional regression models were produced.
Results Median age at diagnosis was 35 years. Most patients were African American (40%) and had stage 1 disease (62.6%). Histologically, 96% were endometrioid, 1.3% clear cell, and 2.7% had both types. Grades 1, 2 and 3 were 54.7%, 26.7% and 9.3%, respectively. Notably, 78.7 % were obese, 8% had recurrence, and 1 patient died from renal failure superimposed on metastatic EC within 3 months of hysterectomy. Lymphovascular invasion (LVI) was present in 28% and uterine serosal invasion (USI) in 4%. In HGEC cases, when compared to low-grade cases, LVI was in 85.7% (p<0.001) and USI in 28.6% (p<0.013). Mismatch repair test results available in 9.3% of cases showed intact expression. The 5-year OS and RFS rates were 98% (95% CI, 94.2–100.0) and 86.8% (95% CI, 76.3–98.7), respectively. The median follow-up time of OS and RFS was 2.4 years (95% CI, 1.1–5.0) and 3.3 years (95% CI, 1.1–6.4), respectively. RFS showed no association with FIGO grade (HR, 4.25; 95% CI, 0.74–19.26; p=0.097).
Conclusion HGEC is rare in young. Accurate diagnosis of HGEC is important to avoid aggressive surgical treatment, especially in young women desiring fertility.
Disclosures The authors declares that (s)he has no relevant or material financial interests that relate to the research described in this abstract’.
