title: Clinical/pathologic features and patient outcome in early onset endometrial carcinoma: a population based analysis and an institutional perspective from the Detroit metropolitan area, Michigan.
abstract: OBJECTIVE
  Analyze tumor characteristics and outcomes in patients with endometrial carcinoma (EC)<40 years of age and compare them to the characteristics of patients ≥ 40 years of age.
  
  
  METHODS
  10,700 patients (305 patients <40 years of age) diagnosed between 1988 and 2007 with EC from the Metropolitan Detroit Cancer Surveillance System (MDCSS), and 884 patients (42 patients <40 years of age) diagnosed between 1996 and 2008 with EC from our institutional database were identified. Differences in clinical and demographic variables by age (<40 vs. ≥ 40) were assessed for statistical significance by chi-square tests. Cox proportional hazards models were used to calculate adjusted hazard ratios (HR) and their 95% confidence intervals (95% CI) to assess the risk of death from all causes.
  
  
  RESULTS
  MDCSS based analysis: Patients<40 were more likely to present with low grade tumors (p<0.0001) and endometroid histology (p=0.0004) but less likely to undergo surgery (p=0.0007) or radiotherapy (p=0.0007). A multivariate analysis confirmed the significance of age, grade, and stage in all patients, and that of histologic type, surgery, and race in patients ≥ 40 as independent prognostic factors for overall survival. Institution based analysis: Patients<40 had a higher proportion of patients with BM I ≥ 30 (p=0.04), and presented with a higher frequency of well differentiated (p=0.04) endometrioid tumors (p=0.004) that are less prone to have deep myometrial invasion (p=0.008).
  
  
  CONCLUSIONS
  This study supports the hypothesis of a disease that is biologically and genetically heterogeneous among women of different ages and ethnicities.
authors: Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA. asemaan@med.wayne.edu
authors: Assaad
authors: A
authors: Semaan
authors: Rouba
authors: R
authors: Ali-Fehmi
authors: Adnan R
authors: AR
authors: Munkarah
authors: Sudeshna
authors: S
authors: Bandyopadhyay
authors: Robert T
authors: RT
authors: Morris
authors: Sara
authors: S
authors: Rizk
authors: Ismail
authors: I
authors: Mert
authors: Julie J
authors: JJ
authors: Ruterbusch
authors: Michele L
authors: ML
authors: Cote
mesh_terms: D000328:Adult; D000367:Age Factors; D018269:Carcinoma, Endometrioid / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008824:Michigan / Q000453:epidemiology; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D018426:SEER Program; D016896:Treatment Outcome