Malignant Uterine Neoplasms Attended at a Brazilian Regional Hospital: 16-years Profile and Time Elapsed for Diagnosis and Treatment

Candido, Elaine Cristina; Veiga Junior, Nelio Neves; Minari, Monique Possari; Toledo, Maria Carolina Szymanski; Yela, Daniela Angerame; Teixeira, Julio Cesar

doi:10.1055/s-0040-1718434

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 43 (02) • Feb 2021 • https://doi.org/10.1055/s-0040-1718434 copy

Malignant Uterine Neoplasms Attended at a Brazilian Regional Hospital: 16-years Profile and Time Elapsed for Diagnosis and Treatment

Neoplasias malignas do útero atendidas em hospital regional brasileiro: Perfil em 16 Anos e tempo dispendido até diagnóstico e tratamento

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present study aims to evaluate the profile of endometrial carcinomas and uterine sarcomas attended in a Brazilian cancer center in the period from 2001 to 2016 and to analyze the impact of time elapsed fromsymptoms to diagnoses or treatment in cancer stage and survival.

Methods

This observational study with 1,190 cases evaluated the year of diagnosis, age-group, cancer stage and histological type. A subgroup of 185 women with endometrioid histology attended in the period from 2012 to 2017 was selected to assess information about initial symptoms, diagnosticmethods, overall survival, and to evaluate the influence of the time elapsed from symptoms to diagnosis and treatment on staging and survival. The statistics used were descriptive, trend test, and the Kaplan- Meier method, with p-values < 0.05 for significance.

Results

A total of 1,068 (89.7%) carcinomas (77.2% endometrioid and 22.8% nonendometrioid) and 122 (10.3%) sarcomas were analyzed, with an increasing trend in the period (p < 0.05). Histologies of non-endometrioid carcinomas, G3 endometrioid, and carcinosarcomas constituted 30% of the cases. Non-endometrioid carcinomas and sarcomas weremore frequently diagnosed in patients over 70 years of age and those on stage IV (p < 0.05). The endometrioid subgroup with 185 women reported 92% of abnormal uterine bleeding and 43% diagnosis after curettage. The average time elapsed between symptoms to diagnosis was 244 days, and between symptoms to treatment was 376 days, all without association with staging (p = 0.976) and survival (p = 0.160). Only 12% of the patients started treatment up to 60 days after diagnosis.

Conclusion

The number of uterine carcinoma and sarcoma cases increased over the period of 2001 to 2016. Aggressive histology comprised 30% of the patients and, for endometrioid carcinomas, the time elapsed between symptoms and diagnosis or treatment was long, although without association with staging or survival.

Keywords:
endometrial neoplasms; uterine sarcomas; epidemiology; neoplasm staging; survival analysis

Histological types	n	%
Carcinomas	1,068	89.7
Endometrioid	825	77.2
Grade^* * Degree of histological differentiation. 1	(286)	(34.7)
Grade 2	(485)	(58.8)
Grade 3	(54)	(6.5)
Non endometrioid	243	22.8
Serous or papillary	(90)	(37.0)
Clear cells	(48)	(19.8)
Mucinous	(24)	(9.9)
Squamous cell	(9)	(3.7)
Poor or undifferentiated	(27)	(11.1)
Neuroendocrine	(3)	(1.2)
Mixed	(39)	(16.1)
Other	(3)	(1.2)
Sarcomas	122	10.3
Carcinosarcoma^ Carcinosarcomas were considered together with sarcomas, although they follow the staging of carcinomas.	(57)	(46.7)
Leiomyosarcoma	(27)	(22.1)
Endometrial stromal sarcoma	(20)	(16.5)
Adenosarcoma	(17)	(13.9)
Other (rhabdomyosarcoma)	(1)	(0.8)

Variable	Carcinomas (n = 1,068)		Sarcomas (n = 122)		Total (n = 1,190)
Variable	n	%	n	%	n	%
Age group (years)
< 50	90	8.4	20	16.4	110	9.3
50–59	302	28.3	27	22.1	329	27.7
60–69	402	37.6	33	27.1	435	36.5
≥70	274	25.7	42	34.4	316	26.5
Stage^* * Staging system according to FIGO-2014 for carcinomas and FIGO-2009 for sarcomas.
I	615	57.7	54	42.2	669	56.2
II	126	11.8	13	10.7	139	11.7
III	250	23.4	29	23.8	279	23.5
IV	76	7.1	26	21.3	102	8.6
Miss information	1				1

Characteristic	n	%
Symptom (sign) at diagnosis^* * considered only the main one.
Uterine abnormal bleeding	171	92.4
Endometrial thickening (ultrasound)	7	3.8
Vaginal discharge	4	2.2
Pelvic pain	2	1.1
Abnormal clinical exam	1	0.5
Diagnostic method
Dilation and curettage	80	43.2
Hysteroscopy	67	36.2
Aspiration biopsy	33	17.9
Hysterectomy	5	2.7
Symptom to diagnosis time (days)
Mean (SD)	244 (±44)
≤ 90	45	24.3
91–180	48	25.9
181–365	56	30.3
> 365	36	19.5
Diagnosis to treatment time (days)^ Three patients did not receive treatment for advanced disease and were early dead.
Mean (SD)	131 (±71)
≤ 60	22	12.1
61–90	17	9.3
> 90	143	78.6
Symptom to treatment time (days)^ Three patients did not receive treatment for advanced disease and were early dead.
Mean (SD)	376 (±49)
≤ 180	33	18.1
181–365	72	39.6
> 365	77	42.3

Stage^* * Staging system according to FIGO-2014; p = 0.976 (Chi-square test).	Symptom to diagnosis time (days)
	≤ 90		91–180		181–365		> 365
	n	%	n	%	n	%	n	%
I	27	60.0	33	68.7	38	67.8	24	66.7
II	7	15.6	7	14.6	8	14.3	5	13.9
III and IV	11	24.4	8	16.7	10	17.9	7	19.4
Total	45	100	48	100	56	100	36	100

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[1] Address for correspondence Julio Cesar Teixeira, Department of Obstetrics andGynecology, Faculty ofMedical Sciences, Universidade Estadual de Campinas, Rua Alexander Fleming, 101, Cidade Universitaria, Campinas, SP 13083-881, Brazil (e-mail: juliotex@unicamp.br; juliotex10@gmail.com).