Clinicopathological Characteristics Of Endometrial Carcinoma With Uterine Fibroids

Background and objectiveEndometrial carcinoma(EC)is one of the most common cancers of the female reproductive system.It has a incidence of 8.4 per 100,000 persons per year worldwide[1],and 63.4 per 100,000 persons per year in China[2].Recently the morbidity of endometrial carcinoma is increasing and affecting younger populations[3].Uterine leiomyoma is the most frequent gynecologic benign tumor in women of reproductive age.According to the autopsies,20 percent of women over 30 year-old have uterine leiomyomas[4].It is common in clinical work that endometrial carcinoma patients suffer from uterine leiomyomas.Although we are still not completely understood the pathogenesis of both diseases,effects of sex hormone have been proved.In the absence of progesterone,long-term stimulation of estrogen alone is closely related to the onset of type I endometrial carcinoma.Long-term simulation of estrogen leads to endometrial hyperplasia happened eventually into cancerous.The expression of estrogen and progesterone receptor is up-regulated in uterine leiomyoma.Estrogen and progestin make effect synergistically to promote growth of uterine leiomyomas.Estrogen as a co stimulator of endometrial carcinoma and uterine leiomyoma,may lead these two diseases to be closely related in occurrence and development.Current studies found that women with uterine leiomyoma have about a 2 to 3-fold increased risk of uterine malignancies[5],and uterine leiomyoma may be one of the risk factors for endometrial carcinoma[1].Limited literature also indicated that endometrial carcinoma with leiomyoma has fewer risk factors and better prognosis[6-8].However,there are some limitations in these studies,such as insufficient samples,incomplete research indexes or unreasonable statistical analysis methods.More investigations are needed to verified the link between uterine leiomyoma and the prognosis of endometrial carcinoma.This study included risk factors related to the occurrence and prognosis of endometrial carcinoma,such as histological grade,surgical pathological stage,myometrial invasion,blood glucose level and history of pregnancy and childbirth,etc.To analyze the influence of uterine leiomyoma on these research indexes and the relationship between uterine leiomyoma and the prognosis of endometrial carcinoma.MethodsA retrospective analysis of 896 cases with endometrial carcinoma treated by surgery in Shandong Provincial Hospital affiliated to Shandong University from Jan.2015 to Oct.2019 was made.Patients were divided into endometrial carcinoma with leiomyoma group and pure endometrial carcinoma group.At the same time,patients with uterine leiomyoma were divided into multiple leiomyomas group and single leiomyoma group according to the number of leiomyomas.To analyze the characteristics of endometrial carcinoma with uterine leiomyoma,and the relationship between leiomyoma number and these risk factors.Results1.Compared with pure endometrial carcinoma group,endometrial carcinoma with leiomyoma group is more in endometrioid carcinoma(?2=7.26),more superficial in myometrial invasion(Z=-2.29),lower in histological grade(Z=-2.28),smaller in the maximum diameter of tumor(Z=-3.96),earlier in operational and pathological stage(Z=-4.02),lower in the rate of pelvic lymph node metastasis(?2=5.17)and higher in the rate of ER(?2=4.40)and PR expression(?2=4.89),and all differences have statistical significance(P?0.05).There was no significant difference between the two groups in Ca125(Z=-1.72,P=0.09),parity(?=1.80,P=0.18),blood glucose level(Z=-0.03,P=0.97)and the number of hypertensive patients(?2=0.36,P=0.55).2.Pathological type(x2=0.18,P=0.67),myometrial invasion(Z=-0.27,P=0.79),histological grade(Z=-0.15,P=0.88),the maximum diameter of tumor(Z=-0.57,P=0.57),operation and pathological stage(Z=-0.77,P=0.44),the rate of pelvic lymph node metastasis(?2=2.28,P=0.13),and the expression rate of ER(?2=0.00,P=0.98)and PR(?2=2.82,P=0.09)showed no significant difference between single leiomyoma group and multiple leiomyomas group.3.The evaluation efficiency of leiomyoma on the prognosis of endometrial carcinoma:area under curve(AUC)of receiver operating characteristic(ROC)curve was 0.69(95%CI:0.60-0.77,P<0.01),sensitivity was 46%,and specificity was 90%.Conclusion1.Endometrial carcinoma with leiomyoma is higher in the proportion of endometrioid carcinoma,more superficail in the depth of myometrial invasion,lower in the histological grade,smaller in the maximum diameter of tumor,earlier in the surgical and pathological stage,lower in the pelvic lymph node metastasis rate and higher in the positive cases of ER and PR,so the prognosis of endometrial carcinoma with leiomyoma is better,but the number of leiomyoma has no significant correlation with the prognosis;2.Uterine leiomyoma may be an index to evaluate the prognosis of endometrial carcinoma,but its evaluation efficiency needs further verification.