Risk of Concurrent Endometrial Carcinoma in Patients Diagnosed With Atypical Endometrial Hyperplasia: A Retrospective...

Background Atypical endometrial hyperplasia (AEH) is a premalignant lesion of the endometrium with a substantial risk of coexisting endometrial carcinoma (EC). Identification of concurrent carcinomas is important for appropriate surgical planning and patient management. This study evaluated the prevalence of concurrent EC in patients diagnosed with AEH and investigated associated clinicopathological risk factors. Methodology This retrospective observational study included 260 women with a histopathological diagnosis of AEH based on preoperative endometrial sampling, who subsequently underwent hysterectomy between January 2020 and December 2024. Demographic, clinical, radiological, and pathological data were retrieved from medical records. Continuous variables were compared using the independent-samples t-test, whereas categorical variables were analyzed using the chi-squared test. Binary logistic regression analysis was performed to identify independent predictors of concurrent EC. Results The mean age of the study population was 52.4 ± 9.8 years, and the mean body mass index (BMI) was 28.6 ± 5.4 kg/m². Concurrent EC was identified in 98 of the 260 patients, with a prevalence of 37.7%. Patients with concurrent EC were significantly older (56.3 ± 9.6 vs. 50.1 ± 9.3 years; p < 0.001), had higher BMI (30.7 ± 5.4 vs. 27.4 ± 5.1 kg/m²; p < 0.001), and greater endometrial thickness (17.1 ± 6.1 vs. 12.6 ± 4.9 mm; p < 0.001) than those without carcinoma. Postmenopausal status (p = 0.041), diabetes mellitus (p = 0.010), obesity (p = 0.002), abnormal uterine bleeding (p = 0.025), and endometrial thickness ≥15 mm (p < 0.001) were significantly associated with concurrent EC. Endometrioid adenocarcinoma was the predominant subtype, with most tumors classified as grade 1 and International Federation of Gynecology and Obstetrics (FIGO) stage IA. Multivariate analysis identified increasing age (adjusted odds ratio (aOR) = 1.05; p = 0.007), obesity (aOR = 1.94; p=0.027), and endometrial thickness ≥15 mm (aOR = 4.12; p < 0.001) as independent predictors of concurrent carcinoma. Conclusions More than one-third of patients with AEH harbored concurrent EC during hysterectomy. Advanced age, obesity, and increased endometrial thickness are significant independent predictors of occult malignancy and may aid in preoperative risk stratification and clinical decision-making.