Abstract
To inform treatment decisions in women diagnosed with endometrial hyperplasia, quantification of the potential for concurrent endometrial cancer and the future risk of progression to cancer is required. We identified studies up to September 2018 that reported on the prevalence of concurrent cancer (within three months of endometrial hyperplasia diagnosis), or the incidence of cancer, identified at least three months after hyperplasia diagnosis. Random-effects meta-analyses produced pooled estimates and 95% confidence intervals (CIs). A total of 36 articles were identified; 15 investigating concurrent and 21 progression to cancer. In pooled analysis of 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 32.6% (95% CI: 24.1%, 42.4%) while no studies evaluated concurrent cancer in non-atypical hyperplasia. The risk of progression to cancer was high in atypical hyperplasia (n = 5 studies, annual incidence rate = 8.2%, 95% CI 3.9%, 17.3%) and only one study reported on non-atypical hyperplasia (annual incidence rate = 2.6%, 95% CI: 0.6%, 10.6%). Overall, a third of women with atypical hyperplasia had concurrent endometrial cancer, although the number of studies, especially population-based, is small. Progression to cancer in atypical hyperplasia was high, but few studies were identified. Population-based estimates are required, in both atypical and non-atypical hyperplasia patients to better inform treatment strategies.
Highlights
Endometrial cancer is the 6th most commonly diagnosed cancer in women worldwide, with the highest rates observed in developed countries, including the United States and Europe [1]
In pooled analysis of 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 32.6% while no studies evaluated concurrent cancer in non-atypical hyperplasia
The risk of progression to cancer was high in atypical hyperplasia (n = 5 studies, annual incidence rate = 8.2%, 95% confidence intervals (CIs) 3.9%, 17.3%) and only one study reported on non-atypical hyperplasia
Summary
Endometrial cancer is the 6th most commonly diagnosed cancer in women worldwide, with the highest rates observed in developed countries, including the United States and Europe [1]. While endometrial hyperplasia can progress to endometrial cancer, the rate of progression depends on factors such as the degree of architectural abnormality and the presence or absence of nuclear atypia [6]. It is well-established that progression to endometrial cancer is higher in women with atypical compared with non-atypical hyperplasia but the magnitude of this risk is uncertain [7, 8], as most published studies have been conducted in single-center and tertiary referral centers which could overestimate risk in comparison to population-based studies. To inform treatment decisions in women diagnosed with endometrial hyperplasia, quantification of the potential for concurrent endometrial cancer and the future risk of progression to cancer is required
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