title: Prediction of concurrent endometrial carcinoma in women with endometrial hyperplasia.
abstract: OBJECTIVE
  Although 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  The 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≥35kg/m(2) (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.
  
  
  CONCLUSIONS
  Older age, obesity, diabetes mellitus, and CAH are predictive of concurrent endometrial carcinoma in endometrial hyperplasia patients.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. Electronic address: koji.matsuo@med.usc.edu.
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: Amin A
authors.initials: AA
authors.lastname: Ramzan
authors.affiliation: Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Gualtieri
authors.affiliation: Department of Pathology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: Paulette
authors.initials: P
authors.lastname: Mhawech-Fauceglia
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Machida
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: Aida
authors.initials: A
authors.lastname: Moeini
authors.affiliation: Female Pelvis Medicine Reconstructive Surgery, Department of Obstetrics Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Dancz
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Roman
mesh_terms: D000328:Adult; D000367:Age Factors; D018269:Carcinoma, Endometrioid / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004714:Endometrial Hyperplasia / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D016889:Endometrial Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009765:Obesity / Q000453:epidemiology*; D012307:Risk Factors
keywords: Age; Diabetes; Endometrial cancer; Endometrial hyperplasia; Obesity; Risk factor