Clinicopathological Profile of Carcinoma Endometrium in a Single Institution of Kerala, India

The incidence of endometrial cancer is on the rise in India, particularly in Kerala. A comprehensive understanding of the clinicopathological profile of endometrial cancer can help identify the underlying factors driving this trend and facilitate the development of targeted preventive strategies and effective management policies.

This register-based retrospective study analyzed clinicopathological patterns in endometrial cancer patients at a tertiary care hospital in Kerala from 2013 to 2019, with Institutional Review Board and Scientific Committee clearance.

A total of 476 patients were identified with endometrial cancer diagnosed and/or treated at our institution. The mean age was 57.9 years (standard deviation [SD] ± 9.5 years) with 73.3% (n = 349) postmenopausal, 14.1% (n = 67) perimenopausal/unknown status, and 12.6% (n = 60) premenopausal. Histopathological analysis showed 80.0% (n = 381) endometrioid, 8% (n = 38) carcinosarcoma, 6.3% (n = 30) serous, 3.6% (n = 17) clear cell, 1.9% (n = 9) un/dedifferentiated, and 0.2% (n = 1) a rare squamous cell carcinoma. Out of 406 patients with available tumor grading, 50% (n = 203) were classified as Grade 1, 15.8% (n = 64) as Grade 2, and 34.2% (n = 139) as Grade 3. There was a significant relationship between age and tumor grade; the mean age of occurrence of high grade was 61 years (SD ± 9.8), and low grade was 56.5 (SD ± 8.6) (P = <0.001). Age also correlated with the incidence of endometrioid or nonendometrioid tumors (mean age 56.7 ± 9.1 years vs. 62.2 ± 9.4 years, P = <0.001). Nonendometrioid tumors were diagnosed in advanced stages compared to endometrioid type (38.1% vs. 20.8% in Stage III/IV, P = 0.004). The tumor size was directly correlated with advanced stage, tumor grade, and myometrial invasion. Specifically, the likelihood of diagnosis at an advanced stage increased with tumor size: 0% for tumors smaller than 2 cm, 11% for tumors measuring 2-4 cm, and 21% for tumors larger than 4 cm (P = 0.001). The deep myometrial invasion occurred in 33.0% of tumors <4 cm versus 68.0% of tumors ≥4 cm (P = <0.001).

The most common type of endometrial cancer is the endometrioid type. Older age is associated with nonendometrioid as well as high-grade disease. Tumor size plays an important role in predicting myometrial invasion, grading, and stage of the disease.