Ofer Gemer1, Yakir Segev2, Limor Helpman3, Nasreen Hag-Yahia3, Ram Eitan4, Oded Raban4, Zvi Vaknin5, Sophia Leytes6, Alon Ben Arie7, Amnon Amit8, Tally Levy6, Ahmed Namazov1, Michael Volodarsky1, Inbar Ben Shachar9, Ilan Atlas10, Ilan Bruchim11, Ofer Lavie12. 1. Barzilai Medical Center, Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel. 2. Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel. Electronic address: segevyakir@yahoo.com. 3. Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel. 4. Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Peta Tikva, Israel. 5. Assaf Haroffe Medical Center, Sackler School of Medicine, Tel Aviv University, Zrifin, Israel. 6. Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Holon, Israel. 7. Kaplan Medical Center, Hebrew University, Rehovot, Israel. 8. Rambam Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel. 9. Ziv Medical Center, Bar Ilan University, Zefat, Israel. 10. Poriya Medical Center, Bar Ilan University, Tiberia, Israel. 11. Hillel Yaffe Medical Center, Rappaport Faculty of Medicine, Technion, Hedera, Israel. 12. Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Abstract
BACKGROUND: Incidental ultrasonographic findings in asymptomatic postmenopausal women, such as thickened endometrium or polyps, often lead to invasive procedures and to the occasional diagnosis of endometrial cancer. Data supporting a survival advantage of endometrial cancer diagnosed prior to the onset of postmenopausal bleeding are lacking. OBJECTIVE: To compare the survival of asymptomatic and bleeding postmenopausal patients diagnosed with endometrial cancer. STUDY DESIGN: This was an Israeli Gynecology Oncology Group retrospective multicenter study of 1607 postmenopausal patients with endometrial cancer: 233 asymptomatic patients and 1374 presenting with postmenopausal bleeding. Clinical, pathological, and survival measures were compared. RESULTS: There was no significant difference between the asymptomatic and the postmenopausal bleeding groups in the proportion of patients in stage II-IV (23.5% vs 23.8%; P = .9) or in high-grade histology (41.0% vs 38.4%; P = .12). Among patients with stage-I tumors, asymptomatic patients had a greater proportion than postmenopausal bleeding patients of stage IA (82.1% vs 66.2%; P < .01) and a smaller proportion received adjuvant postoperative radiotherapy (30.5% vs 40.6%; P = .02). There was no difference between asymptomatic and postmenopausal bleeding patients in the 5-year recurrence-free survival (79.1% vs 79.4%; P = .85), disease-specific survival (83.2% vs 82.2%; P = .57), or overall survival (79.7% vs 76.8%; P = .37). CONCLUSION: Endometrial cancer diagnosed in asymptomatic postmenopausal women is not associated with higher survival rates. Operative hysteroscopy/curettage procedures in asymptomatic patients with ultrasonographically diagnosed endometrial polyps or thick endometrium are rarely indicated. It is reasonable to reserve these procedures for patients whose ultrasonographic findings demonstrate significant change over time.
BACKGROUND: Incidental ultrasonographic findings in asymptomatic postmenopausal women, such as thickened endometrium or polyps, often lead to invasive procedures and to the occasional diagnosis of endometrial cancer. Data supporting a survival advantage of endometrial cancer diagnosed prior to the onset of postmenopausal bleeding are lacking. OBJECTIVE: To compare the survival of asymptomatic and bleeding postmenopausal patients diagnosed with endometrial cancer. STUDY DESIGN: This was an Israeli Gynecology Oncology Group retrospective multicenter study of 1607 postmenopausal patients with endometrial cancer: 233 asymptomatic patients and 1374 presenting with postmenopausal bleeding. Clinical, pathological, and survival measures were compared. RESULTS: There was no significant difference between the asymptomatic and the postmenopausal bleeding groups in the proportion of patients in stage II-IV (23.5% vs 23.8%; P = .9) or in high-grade histology (41.0% vs 38.4%; P = .12). Among patients with stage-I tumors, asymptomatic patients had a greater proportion than postmenopausal bleedingpatients of stage IA (82.1% vs 66.2%; P < .01) and a smaller proportion received adjuvant postoperative radiotherapy (30.5% vs 40.6%; P = .02). There was no difference between asymptomatic and postmenopausal bleedingpatients in the 5-year recurrence-free survival (79.1% vs 79.4%; P = .85), disease-specific survival (83.2% vs 82.2%; P = .57), or overall survival (79.7% vs 76.8%; P = .37). CONCLUSION:Endometrial cancer diagnosed in asymptomatic postmenopausal women is not associated with higher survival rates. Operative hysteroscopy/curettage procedures in asymptomatic patients with ultrasonographically diagnosed endometrial polyps or thick endometrium are rarely indicated. It is reasonable to reserve these procedures for patients whose ultrasonographic findings demonstrate significant change over time.