Malignant Uterine Neoplasms Attended at a Brazilian Regional Hospital: 16-years Profile and Time Elapsed for Diagnosis and Treatment

Abstract

Objective The present study aims to evaluate the profile of endometrial carcinomas and uterine sarcomas attended in a Brazilian cancer center in the period from 2001 to 2016 and to analyze the impact of time elapsed from symptoms to diagnoses or treatment in cancer stage and survival.

Methods This observational study with 1,190 cases evaluated the year of diagnosis, age-group, cancer stage and histological type. A subgroup of 185 women with endometrioid histology attended in the period from 2012 to 2017 was selected to assess information about initial symptoms, diagnostic methods, overall survival, and to evaluate the influence of the time elapsed from symptoms to diagnosis and treatment on staging and survival. The statistics used were descriptive, trend test, and the Kaplan-Meier method, with p-values < 0.05 for significance.

Results A total of 1,068 (89.7%) carcinomas (77.2% endometrioid and 22.8% non-endometrioid) and 122 (10.3%) sarcomas were analyzed, with an increasing trend in the period (p < 0.05). Histologies of non-endometrioid carcinomas, G3 endometrioid, and carcinosarcomas constituted 30% of the cases. Non-endometrioid carcinomas and sarcomas were more frequently diagnosed in patients over 70 years of age and those on stage IV (p < 0.05). The endometrioid subgroup with 185 women reported 92% of abnormal uterine bleeding and 43% diagnosis after curettage. The average time elapsed between symptoms to diagnosis was 244 days, and between symptoms to treatment was 376 days, all without association with staging (p = 0.976) and survival (p = 0.160). Only 12% of the patients started treatment up to 60 days after diagnosis.

Conclusion The number of uterine carcinoma and sarcoma cases increased over the period of 2001 to 2016. Aggressive histology comprised 30% of the patients and, for endometrioid carcinomas, the time elapsed between symptoms and diagnosis or treatment was long, although without association with staging or survival.

Resumo

Objetivo O presente estudo avaliou o perfil dos carcinomas endometriais e sarcomas uterinos atendidos em um centro brasileiro de câncer no período de 2001 a 2016, e avaliou o impacto do tempo decorrido entre os sintomas até o diagnóstico ou tratamento no estadiamento e sobrevida pelo câncer.

Métodos Estudo observacional com 1.190 casos que analisou o ano do diagnóstico, faixa etária, estágio e tipo histológico do câncer. Um subgrupo de 185 mulheres com histologia endometrioide e atendidas no período de 2012 a 2017 foi selecionado para avaliar informações sobre sintomas iniciais, métodos de diagnóstico, sobrevida global e para analisar a relação entre o tempo decorrido a partir dos sintomas até o diagnóstico e tratamento no estadiamento e sobrevida. Foram realizadas análises estatísticas descritiva, de tendência linear e de sobrevida pelo método de Kaplan-Meier, com valores de p < 0,05 para significância.

Resultados Os casos estudados de acordo com a histologia foram 1.068 (89,7%) carcinomas (77,2% endometrioides e 22,8% não endometrioides) e 122 (10,3%) sarcomas, com tendência crescente no período (p < 0,05). Histologias de carcinomas não endometrioides, G3 endometrioides e carcinossarcomas consistiram em 30% dos casos. Carcinomas não endometrioides e sarcomas foram mais frequentemente diagnosticados em pacientes acima de 70 anos de idade e em estágio IV (p < 0,05). O subgrupo com 185 mulheres com carcinoma endometrioide apresentou 92% de sangramento uterino anormal e 43% de diagnóstico após curetagem. O tempo médio decorrido entre os sintomas e o diagnóstico foi de 244 dias e entre os sintomas e o tratamento, 376 dias, todos sem associação com estadiamento (p = 0,976) e sobrevida (p = 0,160). Apenas 12% das pacientes iniciaram o tratamento em até 60 dias após o diagnóstico.

Conclusão O número de casos de carcinomas e sarcomas uterinos aumentaram no período de 2001 a 2016. A histologia agressiva compreendeu 30% dos pacientes e, no caso dos carcinomas endometrioides, o tempo decorrido entre os sintomas e o diagnóstico ou tratamento foi longo, embora sem associação com estadiamento ou sobrevida.

Keywords

endometrial neoplasms - uterine sarcomas - epidemiology - neoplasm staging - survival analysis

Palavras-chave

neoplasias endometriais - sarcomas uterinos - epidemiologia - estadiamento de neoplasia - análise de sobrevivência

Contributions

Each author has participated actively and sufficiently in this work and all had final approval of the manuscript version being submitted. E. C. contributed to conception and design, data collection, interpretation of data, and writing of the article; N. V. J. contributed to conception, data collection, and writing of the article; M. M. contributed to data collection and writing of the article; M. T. contributed to interpretation of data and writing of the article; D. Y. contributed to conception and design, interpretation of data, and critical review of the article; and J. T. contributed to conception and design, data collection and analysis, interpretation of data, and writing of the article.

Publication History

Received: 27 April 2020

Accepted: 03 August 2020

Article published online:
19 January 2021

• References

• 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424 DOI: 10.3322/caac.21492.
• 2 Ministério da Saúde, Instituto Nacional de Câncer José Alencar Gomes da Silva. Estimativa 2020: incidência de câncer no Brasil [Internet]. Rio de Janeiro: INCA; 2019 [cited 2020 Jan 11]. Available from: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2020-incidencia-de-cancer-no-brasil.pdf
• 3 Boll D, Verhoeven RH, van der Aa MA, Pauwels P, Karim-Kos HE, Coebergh JWW, van Doorn HC. Incidence and survival trends of uncommon corpus uteri malignancies in the Netherlands, 1989-2008. Int J Gynecol Cancer 2012; 22 (04) 599-606 DOI: 10.1097/igc.0b013e318244cedc.
• 4 Jamison PM, Altekruse SF, Chang JT, Zahn J, Lee R, Noone AM, Barroilhet L. Site-specific factors for cancer of the corpus uteri from SEER registries: collaborative stage data collection system, version 1 and version 2. Cancer 2014; 120 (Suppl. 23) 3836-3845 DOI: 10.1002/cncr.29054.
• 5 D'Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol 2010; 116 (01) 131-139 DOI: 10.1016/j.ygyno.2009.09.023.
• 6 Felix AS, Yang HP, Bell DW, Sherman ME. Epidemiology of endometrial carcinoma: etiologic importance of hormonal and metabolic influences. Adv Exp Med Biol 2017; 943: 3-46 DOI: 10.1007/978-3-319-43139-0_1.
• 7 Fortner RT, Hüsing A, Dossus L, Tjønneland A, Overvad K, Dahm CC. et al. Theoretical potential for endometrial cancer prevention through primary risk factor modification: Estimates from the EPIC cohort. Int J Cancer 2020; 147 (05) 1325-1333 DOI: 10.1002/ijc.32901.
• 8 Travis LB, Ng AK, Allan JM, Pui CH, Kennedy AR, Xu XG. et al. Second malignant neoplasms and cardiovascular disease following radiotherapy. J Natl Cancer Inst 2012; 104 (05) 357-370 DOI: 10.1093/jnci/djr533.
• 9 AlHilli MM, Mariani A, Bakkum-Gamez JN, Dowdy SC, Weaver AL, Peethambaram PP. et al. Risk-scoring models for individualized prediction of overall survival in low-grade and high-grade endometrial cancer. Gynecol Oncol 2014; 133 (03) 485-493 DOI: 10.1016/j.ygyno.2014.03.567.
• 10 Tropé CG, Abeler VM, Kristensen GB. Diagnosis and treatment of sarcoma of the uterus. A review. Acta Oncol 2012; 51 (06) 694-705 DOI: 10.3109/0284186X.2012.689111.
• 11 Organização Mundial de Saúde. CID-O: Classificação Internacional de Doenças para Oncologia. 3a ed.. São Paulo: Editora da Universidade de São Paulo/Fundação Oncocentro de São Paulo; 2005
• 12 Governo do Estado de São Paulo. Regiões Administrativas do Estado de São Paulo: Região Administrativa Campinas [Internet]. 2018 [cited 2020 Apr 12]. Available from: https://www.desenvolvesp.com.br/mapadaeconomiapaulista/ra/campinas/
• 13 Prat J. FIGO staging for uterine sarcomas. Int J Gynaecol Obstet 2009; 104 (03) 177-178 DOI: 10.1016/j.ijgo.2008.12.008.
• 14 FIGO Committee on Gynecologic Oncology. FIGO staging for carcinoma of the vulva, cervix, and corpus uteri. Int J Gynaecol Obstet 2014; 125 (02) 97-98 DOI: 10.1016/j.ijgo.2014.02.003.
• 15 Kurman RJ, Carcangiu ML, Herrington CS, Young RH. , Eds. WHO Classification of Tumours of Female Reproductive Organs. 4th ed.. Lyon: IARC; 2014
• 16 Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 1983; 15 (01) 10-17 DOI: 10.1016/0090-8258(83)90111-7.
• 17 Secretaria de Estado da Saúde de São Paulo. Mendes JDV, Cruz RMF, Portas SLC. , organizadores. Plano Estadual de Saúde-PES: 2016–2019 [Internet]. São Paulo: SES/SP; 2015. [cited 2020 Mar 12]. Available from: http://www.saude.sp.gov.br/resources/ses/perfil/gestor/documentos-de-planejamento-em-saude/plano-estadual-de-saude-2016-2019-sessp/pessp_2017_11_01_17.pdf
• 18 Pérez-Mancera PA, Young AR, Narita M. Inside and out: the activities of senescence in cancer. Nat Rev Cancer 2014; 14 (08) 547-558 DOI: 10.1038/nrc3773.
• 19 Brooks SE, Zhan M, Cote T, Baquet CR. Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989-1999. Gynecol Oncol 2004; 93 (01) 204-208 DOI: 10.1016/j.ygyno.2003.12.029.
• 20 Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F. Factors associated with Type I and Type II endometrial cancer. Cancer Causes Control 2010; 21 (11) 1851-1856 DOI: 10.1007/s10552-010-9612-8.
• 21 Amant F, Mirza MR, Koskas M, Creutzberg CL. Cancer of the corpus uteri. Int J Gynaecol Obstet 2018; 143 (Suppl. 02) 37-50 DOI: 10.1002/ijgo.1261296–S104.
• 22 Paulino E, Nogueira-Rodrigues A, Goss PE, Faroni L, Guitmann G, Strasser-Weippl K. et al. Endometrial cancer in Brazil: preparing for the rising incidence. Rev Bras Ginecol Obstet 2018; 40 (10) 577-579 DOI: 10.1055/s-0038-1673644.
• 23 Entra em vigor hoje a Lei dos 60 dias para tratamento do câncer [Internet]. 2013 [cited 2020 Apr 12]. Available from: http://www.blog.saude.gov.br/servicos/32374-entra-em-vigor-hoje-a-lei-dos-60-dias-para-tratamento-do-cancer
• 24 Svanvik T, Sundfeldt K, Strömberg U, Holmberg E, Marcickiewicz J. Population-based cohort study of the effect of endometrial cancer classification and treatment criteria on long-term survival. Int J Gynaecol Obstet 2017; 138 (02) 183-189 DOI: 10.1002/ijgo.12214.