Prediction of concurrent endometrial carcinoma in women with endometrial hyperplasia

•Older age, larger body habitus, diabetes mellitus, and complex hyperplasia with atypia were independent risk factors predicting concurrent endometrial cancer.•Up to 45.5% of endometrial hyperplasia patients can harbor concurrent endometrial cancer if multiple risk factors are present.•Hormonal treatment for endometrial hyperplasia may be beneficial among patients expressing 3 or more risk factors.

ObjectiveAlthough a fraction of endometrial hyperplasia cases have concurrent endometrial carcinoma, patient characteristics associated with concurrent malignancy are not well described. The aim of our study was to identify predictive clinico-pathologic factors for concurrent endometrial carcinoma among patients with endometrial hyperplasia.MethodsA case–control study was conducted to compare endometrial hyperplasia in both preoperative endometrial biopsy and hysterectomy specimens (n = 168) and endometrial carcinoma in hysterectomy specimen but endometrial hyperplasia in preoperative endometrial biopsy (n = 43). Clinico-pathologic factors were examined to identify independent risk factors of concurrent endometrial carcinoma in a multivariate logistic regression model.ResultsThe most common histologic subtype in preoperative endometrial biopsy was complex hyperplasia with atypia [CAH] (n = 129) followed by complex hyperplasia without atypia (n = 58) and simple hyperplasia with or without atypia (n = 24). The majority of endometrial carcinomas were grade 1 (86.0%) and stage I (83.7%). In multivariate analysis, age 40–59 (odds ratio [OR] 3.07, p = 0.021), age ≥ 60 (OR 6.65, p = 0.005), BMI ≥ 35 kg/m2 (OR 2.32, p = 0.029), diabetes mellitus (OR 2.51, p = 0.019), and CAH (OR 9.01, p = 0.042) were independent predictors of concurrent endometrial carcinoma. The risk of concurrent endometrial carcinoma rose dramatically with increasing number of risk factors identified in multivariate model (none 0%, 1 risk factor 7.0%, 2 risk factors 17.6%, 3 risk factors 35.8%, and 4 risk factors 45.5%, p < 0.001). Hormonal treatment was associated with decreased risk of concurrent endometrial cancer in those with ≥ 3 risk factors.ConclusionsOlder age, obesity, diabetes mellitus, and CAH are predictive of concurrent endometrial carcinoma in endometrial hyperplasia patients.