Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia.
PURPOSE The severity of endometrial hyperplasia (EH)-simple (SH), complex (CH), or atypical (AH)-influences clinical management, but valid estimates of absolute risk of clinical progression to carcinoma are lacking. Materials and METHODS We conducted a case-control study nested in a cohort of 7,947 women diagnosed with EH (1970-2002) at one prepaid health plan who remained at risk for at least 1 year. Patient cases (N = 138) were diagnosed with carcinoma, on average, 6 years later (range, 1 to 24 years). Patient controls (N = 241) were matched to patient cases on age at EH, date of EH, and duration of follow-up, and they were counter-matched to patient cases on EH severity. After we independently reviewed original slides and medical records of patient controls and patient cases, we combined progression relative risks (AH v SH, CH, or disordered proliferative endometrium [ie, equivocal EH]) from the case-control analysis with clinical censoring information (ie, hysterectomy, death, or left the health plan) on all cohort members to estimate interval-specific (ie, 1 to 4, 5 to 9, and 10 to 19 years) and cumulative (ie, through 4, 9, and 19 years) progression risks. Results For nonatypical EH, cumulative progression risk increased from 1.2% (95% CI, 0.6% to 1.9%) through 4 years to 1.9% (95% CI, 1.2% to 2.6%) through 9 years to 4.6% (95% CI, 3.3% to 5.8%) through 19 years after EH diagnosis. For AH, cumulative risk increased from 8.2% (95% CI, 1.3% to 14.6%) through 4 years to 12.4% (95% CI, 3.0% to 20.8%) through 9 years to 27.5% (95% CI, 8.6% to 42.5%) through 19 years after AH. CONCLUSION Cumulative 20-year progression risk among women who remain at risk for at least 1 year is less than 5% for nonatypical EH but is 28% for AH.
Lacey
James V
JV
City of Hope, 1500 East Duarte Rd, Duarte, CA 91010-3000, USA. jlacey@coh.org
Sherman
Mark E
ME
Rush
Brenda B
BB
Ronnett
Brigitte M
BM
Ioffe
Olga B
OB
Duggan
Máire A
MA
Glass
Andrew G
AG
Richesson
Douglas A
DA
Chatterjee
Nilanjan
N
Langholz
Bryan
B
D000368:Aged; D001706:Biopsy; D002277:Carcinoma / Q000453:epidemiology* / Q000473:pathology; D016022:Case-Control Studies; D018450:Disease Progression; D004714:Endometrial Hyperplasia / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors