title: The presence of postmenopausal bleeding as prognostic parameter in patients with endometrial cancer: a retrospective multi-center study.
abstract: BACKGROUND
  To date, there is no consensus on the utility of screening procedures for the early detection of endometrial cancer. The value of transvaginal ultrasound for screening of asymptomatic endometrial cancer has been discussed controversially. This study was conducted to evaluate whether asymptomatic patients with endometrial cancer have a better prognosis than symptomatic patients with endometrial cancer diagnosed after postmenopausal bleeding.
  
  
  METHODS
  In the present multi-center study, the effect of the presence of postmenopausal bleeding on prognosis was evaluated retrospectively in 605 patients with endometrial cancer using patients' files. 543 patients (133 patients were asymptomatic, 410 patients were symptomatic) with endometrioid endometrial cancer were enrolled in all further analysis. Student's t-test, Cox regression analysis and Kaplan-Meier analysis were used were appropriate.
  
  
  RESULTS
  Presence/absence of a postmenopausal bleeding was not associated with tumor stage (p = 0.2) and age at diagnosis (p = 0.5). Asymptomatic patients with endometrial cancer had a significantly higher rate of well and moderate-differentiated tumors compared to symptomatic patients (p = 0.008). In univariable and multivariable survival analysis, tumor stage, tumor grade, and patients' age at diagnosis, but not presence/absence of a postmenopausal bleeding, were associated with disease free and overall survival.
  
  
  CONCLUSIONS
  Asymptomatic patients with endometrial cancer have a higher rate of well differentiated tumors compared to patients with a postmenopausal bleeding prior to diagnosis. The prognosis of both groups of patients was similar.
authors.affiliation: Department of Obstetrics & Gynecology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. veronika.seebacher@meduniwien.ac.at
authors.forename: Veronika
authors.initials: V
authors.lastname: Seebacher
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schmid
authors.forename: Stephan
authors.initials: S
authors.lastname: Polterauer
authors.forename: Katrin
authors.initials: K
authors.lastname: Hefler-Frischmuth
authors.forename: Heinz
authors.initials: H
authors.lastname: Leipold
authors.forename: Nicole
authors.initials: N
authors.lastname: Concin
authors.forename: Alexander
authors.initials: A
authors.lastname: Reinthaller
authors.forename: Lukas
authors.initials: L
authors.lastname: Hefler
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D016889:Endometrial Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D017698:Postmenopause; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014592:Uterine Hemorrhage / Q000175:diagnosis* / Q000209:etiology