Young Women With Endometrial Cancer: A Portuguese Perspective

Endometrial cancer (EC) is rare in premenopausal women. The aim of this study was to describe the demographic, clinical and pathological characteristics and compare survival in the light of pathological aspects of EC in young women.

We performed a retrospective observational cohort study, analyzing data from 29 women up to 45 years of age diagnosed between 2003 and 2023 at our Institution.

The most common risk factor for EC was excess weight (75% of patients), followed by nulliparity (62.1%), diabetes mellitus (20.7%) and hypertension (17.2%). Twenty-seven patients were submitted to total hysterectomy and salpingo-oophorectomy, and additional procedures were performed for half of the patients, in particular lymph node staging (46.4%), omentectomy (17.9%) and debulking (7.1%). The majority of tumors were low-grade endometrioid (79.3%). In six cases (21.4%), synchronous ovarian cancer occurred. EC was staged FIGO I-II in 22 patients (75.9%) and 13 (46.4%) received adjuvant therapy. Univariate survival analysis showed worse progressive-free and overall survival in patients with high-grade endometrioid tumor (median survival and standard deviation of 39.8±24.2 vs. 156.3±12.7 months, p=0.001; and 56.4±28.5 vs. 156.3±12.7 months, p=0.009, respectively); those with lymphovascular space invasion (68.6±21.9 vs. 161.3±12.5 months, p=0.011; and 79.2±22,5 vs. 161.3±12.5 months, p=0.035, respectively) and with FIGO stages III-IV (68.1±24.9 vs. 146.2±15.2 months, p=0.047; and 68.1±24.9 vs. 152.6±14.5 months, p=0.023, respectively).

Excess weight is a main risk factor for EC and the most prevalent risk factor in our study. In patients with EC, lymphovascular space invasion, poor tumor differentiation and FIGO stage III-IV are important factors associated with reduced progression-free and overall survival.