Clinicopathological Characteristics And Prognostic Factors Of Synchronous Primary Cancers Of The Endometrium And Ovary

BackgroundAccording past Studies,5 percent of women with endometrial carcinoma and 10 percent of women with ovarian carcinoma actually have synchronous primary cancers of the endometrium and ovary(SCEOs).ObjectivesThe aim of this study was to summarize the clinicopathological features of patients with a histomathological diagnosis of SCEOs and to explore prognostic factors.MethodsThis study was a single-center retrospective study of 40 patients with SCEOs who underwent surgical treatment at Qilu Hospital of Shandong University from January 2005 to December 2020 and were pathologically diagnosed.The 40 patients with SCEOs were divided into three groups:Group A:the two cancer foci were pathologically different;Group B(EEC/EOC group):both lesions were endometrioid carcinoma;Group C:Two tumor foci were pathologically identical without endometrioid carcinoma.The clinical and pathological data of patients were collected by searching the medical record database of Qilu Hospital of Shandong University.Results1.Clinical features:The median age of 40 SCEOs patients at diagnosis was 47.8 years old.The initial symptoms were abdominal distension and pain in 60.0%(24/40),irregular vaginal bleeding and drainage in 50.0%(20/40),no significant clinical symptoms in 12.5%(5/40),pre-menopausal in 62.5%(25/40),and non-fertile in 15.0%(6/40).2.Pathological features:Endometrioid carcinoma was the main pathological type in SCEOs patients(67.5%,27/40).Stage I endometrial carcinoma accounted for 67.5%(27/40),and the main pathological grade was G1-G2(85%,34/40).The myometrial invasion was mostly non-myometrial invasion or superficial myometrial invasion(97.5%,39/40).The majority of ovarian cancers were stage I ovarian cancer(92.5%,37/40),and the main pathological grade was G1-G2(80%,32/40),with unilateral ovarian involvement(85.0%,34/40).3.Treatment and prognosis:All 40 patients with SCEOs received surgical treatment,and 32 patients(80.0%)received postoperative adjuvant therapy.Postoperative follow-up ranged from 1 to 163 months,with a mean follow-up time of 52.05 months(95%confidence interval:46.08 to 58.02).During follow-up,4 patients(10%,4/40)relapsed,27 patients were followed up less than 5 years postoperatively,6 of them died,and 21 were still being followed up.The mean postoperative survival time was 135.5±10.2 months,the 5-year disease-free survival rate was 77.1%,and the 5-year overall survival rate was 82.9%.4.Analysis of prognostic factors:Univariate analysis showed that 5-year DFS was worse in patients who were asymptomatic,non-endometrioid carcinoma with EC pathologic type,and without postoperative adjuvant therapy.Patients without clinical symptoms,non-endometrioid carcinoma with EC pathologic type,no postoperative adjuvant therapy,and with pelvic and abdominal lymph node metastasis had worse OS at 5 years(P<0.05).Multivariate analysis showed that absence of clinical symptoms and postoperative adjuvant therapy were independent factors affecting 5-year DFS and OS in SCEOs patients.In addition,the present study also found that stage Ⅱ-Ⅲ pathological stage of EC surgery was also an independent factor affecting 5-year DFS in SCEOs patients,while combined with pelvic and abdominal lymph node metastasis was an independent factor affecting 5-year OS in SCEOs patients(P<0.05).Conclusions1.The initial symptoms of SCEOs patients were mainly abdominal distension,abdominal pain and abnormal vaginal bleeding and drainage.Usually,the onset age of patients is younger,most patients are not postmenopausal at the onset,and have a favorable overall prognosis.2.In this study,endometrioid adenocarcinoma was the main histomathological type of SCEOs patients.Most of the patients had good histopathological differentiation,mostly high or medium differentiation.The pathological stage of surgery was early,and most of them were stage I.3.The average maximum diameter of ovarian tumor in group A was greater than that in group C,the proportion of patients with ascites in group A and B was higher than that in group C,and the proportion of endometrial cancer lesions with pathological grading of G1-G2 in group B was higher than that in group A and C,with statistical significance(P<0.05).4.In this study,no clinical symptoms,no postoperative adjuvant therapy and stage II-III pathological stage of EC were found to be independent factors affecting 5-year DFS in SCEOS patients.Absence of clinical symptoms,no postoperative adjuvant therapy and combined with pelvic and abdominal lymph node metastasis were independent factors affecting 5-year OS in SCEOs patients(P<0.05).