Elevated preoperative hemoglobin A1c is associated with higher stage and grade of endometrial carcinoma

Abstract

Introduction: The incidence of endometrial cancer (EC) and diabetes mellitus has been linked in many studies. EC patients had more severely impaired glucose tolerance than individuals with other malignancies. An indicator that determines glycemic index control is hemoglobin A1c (HbA1c). This study aimed to assess whether the preoperative level of HbA1c in diabetes mellitus patients is related to the stage and grade of endometrial carcinoma. Methods: This cross-sectional study uses a retrospective observational analytic design. Diabetes mellitus patients diagnosed with EC and measured for HbA1c levels in Dr. Kariadi General Hospital Semarang from January 2018 to December 2021 were involved as the subjects of this study. The data was analyzed using correlation analysis and linear regression analysis. A value of p<0.05 was used to determine the statistical significance. Results: This study involved 27 EC patients who had preoperative HbA1c data. The overall average HbA1c was 7.88±1.35 in the early-stage group and 10.85±1.15 in the advanced-stage group, significantly different between groups (p<0.001). There was also a significant difference between HbA1c in low-grade and high-grade tumors (p<0.001). With an increase of HbA1c in one unit value, the endometrial carcinoma stage also increases by 0.323 units or 32.3%, while the grade of endometrial carcinoma also increases by 0.275 units or 27.5%. Conclusion: HbA1c level significantly correlates with both the stage and grade of EC. This study also found a linear relationship between increased HbA1c levels and higher stage and grade of EC, indicating that HbA1c levels influence the stage and grade of endometrial carcinoma.