Sonographic, Demographic, and Clinical Characteristics of Pre- and Postmenopausal Women with Endometrial Cancer; Results from a Post Hoc Analysis of the IETA4 (International Endometrial Tumor Analysis) Multicenter Cohort
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Variables
2.3. Statistical Analyses
3. Results
3.1. Demographic and Anthropometric Characteristics
3.2. Histopathological Characteristics
3.3. Sonographic Characteristics
3.4. Endometrial Thickness in Relation to Anthropometric Characteristics
3.5. Sonographic and Anthropometric Characteristics in Relation to Risk Group
3.6. Results after Controlling the False Discovery Rate
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Premenopausal Women | Postmenopausal Women | ||||
---|---|---|---|---|---|---|
Background | Median | IQR | Median | IQR | Uncorrected p-value | Significance after Benjamini–Yekutieli procedure |
Age | 48 | 43–52 | 66 | 61–72 | NA | |
Parity | N | % | N | % | <0.001 | significant |
0 | 54 | 34% | 230 | 17% | ||
1 | 40 | 25% | 275 | 20% | ||
2 | 52 | 32% | 588 | 43% | ||
3+ | 15 | 9% | 284 | 21% | ||
Family history of cancer | N | % | N | % | ||
Endometrial | 7 | 4% | 94 | 7% | 0.311 | not significant |
Ovarian | 1 | 1% | 20 | 1% | 0.717 | not significant |
Breast | 16 | 10% | 149 | 11% | 0.893 | not significant |
Colon | 26 | 16% | 103 | 7% | 0.001 | significant |
Other | 30 | 19% | 278 | 20% | 0.679 | not significant |
Lifestyle | ||||||
Smoking | 0.398 | not significant | ||||
Never | 122 | 76% | 1047 | 76% | ||
Former | 19 | 12% | 198 | 14% | ||
Present | 20 | 12% | 132 | 10% | ||
Exercise | 0.243 | not significant | ||||
Never | 53 | 33% | 515 | 37% | ||
>20 min, 1–2/w. | 46 | 29% | 436 | 32% | ||
>20 min, ≥3/w. | 44 | 27% | 328 | 24% | ||
Strenuous, 1/w. | 10 | 6% | 54 | 4% | ||
Strenuous, ≥2/w. | 8 | 5% | 44 | 3% | ||
Alcohol use | 0.193 | not significant | ||||
Never | 61 | 38% | 596 | 43% | ||
0–6 units/w. | 89 | 55% | 691 | 50% | ||
7–12 units/w. | 9 | 6% | 85 | 6% | ||
>12 units/w. | 2 | 1% | 5 | 0% | ||
Anthropometric | ||||||
Constitution | 0.024 | not significant | ||||
Abdominal adiposity | 70 | 43% | 742 | 54% | ||
Female adiposity | 32 | 20% | 259 | 19% | ||
Lean | 59 | 37% | 376 | 27% | ||
Median | IQR | Median | IQR | |||
Weight (kg) | 77 | 65–93 | 75 | 65–89 | 0.671 | not significant |
Height (cm) | 165 | 162–170 | 163 | 159–168 | NA | |
BMI (kg/m2) | 27.6 | 23.1–34.6 | 28.4 | 24.4–33.2 | 0.290 | not significant |
Waist circumference (cm) | 92 | 82–108 | 98 | 87–112 | 0.002 | significant |
Bra cup size | N | % | N | % | 0.87 | not significant |
AA-B | 55 | 34% | 443 | 32% | ||
C-D | 87 | 54% | 756 | 55% | ||
E-I | 19 | 12% | 178 | 13% | ||
Co-morbidity | ||||||
Current use of hormonal treatment | 18 | 11% | 160 | 12% | 1 | not significant |
Type 2 diabetes | 11 | 7% | 235 | 17% | NA | |
Hypertension | 35 | 22% | 730 | 53% | NA | |
Bleeding history | ||||||
Abnormal uterine bleeding | 140 | 87% | 1226 | 89% | 0.428 | not significant |
Median | IQR | Median | IQR | |||
Duration of abnormal uterine bleeding (months) | 5 | 3–12 | 3 | 2–6 | <0.001 | significant |
Characteristic | Premenopausal Women | Postmenopausal Women | ||||
---|---|---|---|---|---|---|
N | % | N | % | Uncorrected p-value | Significance after Benjamini–Yekutieli procedure | |
FIGO surgical stage | <0.001 ϕ | significant | ||||
IA | 135 | 84% | 801 | 58% | ||
IB | 9 | 6% | 315 | 23% | ||
II | 7 | 4% | 79 | 6% | ||
III | 10 | 6% | 159 | 12% | ||
IV | 0 | 0% | 23 | 2% | ||
Histologic subtype | ||||||
Endometrioid | 158 | 98% | 1172 | 85% | <0.001 Ω | significant |
Grade 1 | 91 | 58% | 512 | 44% | 0.0012 Ψ | significant |
Grade 2 | 49 | 31% | 463 | 40% | ||
Grade 3 | 18 | 11% | 197 | 17% | ||
Non-endometrioid | 3 | 2% | 205 | 15% | NA | |
Serous | 0 | 0% | 91 | 44% | ||
Carcinosarcoma | 2 | 67% | 39 | 19% | ||
Clear cell carcinoma | 0 | 0% | 33 | 16% | ||
Mixed cell carcinoma | 1 | 33% | 35 | 17% | ||
Undifferentiated | 0 | 0% | 7 | 3% | ||
ESMO-ESGO-ESTRO risk group ε | <0.001 | significant | ||||
Low | 126 | 78% | 636 | 46% | ||
Intermediate/High | 35 | 22% | 741 | 54% |
Finding | Premenopausal Women | Postmenopausal Women | ||||
---|---|---|---|---|---|---|
Sonographic findings, all women | N | % | N | % | Uncorrected p-value | Significance after Benjamini–Yekutieli procedure |
Endometrium | 0.356 | not significant | ||||
Measurable | 154 | 96% | 1274 | 93% | ||
Not measurable | 4 | 2% | 45 | 3% | ||
Not visible | 3 | 2% | 58 | 4% | ||
Tumor | 0.001 | significant | ||||
Defined | 118 | 73% | 1157 | 84% | ||
Not defined | 43 | 27% | 220 | 16% | ||
Myometrium | ||||||
Fibroid present | 48 | 30% | 503 | 37% | 0.099 | not significant |
Adenomyosis suspected | 25 | 16% | 96 | 7% | 0.001 | significant |
Sonographic findings, in women w. visible endometrium only | ||||||
Endometrial–myometrial border | <0.001 | significant | ||||
Regular | 61 | 39% | 298 | 23% | ||
Endometrial echogenicity | ||||||
Uniform | 65 | 41% | 496 | 38% | 0.387 ϕ | not significant |
Hyperechoic | 49 | 75% | 377 | 76% | ||
Hypo-/iso-/three layered | 16 | 25% | 119 | 24% | ||
Non-uniform | 93 | 59% | 823 | 62% | ||
Homogenous w. cysts | 9 | 10% | 70 | 9% | ||
Heterogenous without cysts | 77 | 83% | 661 | 80% | ||
Heterogenous w. cysts | 7 | 8% | 92 | 11% | ||
Bright edge sign | 0.007 | not significant | ||||
Yes | 11 | 7% | 191 | 14% | ||
Endometrial midline | <0.001 | significant | ||||
Seen | 37 | 23% | 147 | 11% | ||
Undefined/not seen | 121 | 77% | 1172 | 89% | ||
Color score | 0.545 Ω | not significant | ||||
No flow | 25 | 16% | 267 | 20% | ||
Minimal flow | 32 | 20% | 246 | 19% | ||
Moderate flow | 65 | 41% | 436 | 33% | ||
Abundant flow | 36 | 23% | 370 | 28% | ||
Vascular pattern | 0.439 Ψ | not significant | ||||
No flow | 25 | 16% | 267 | 20% | ||
Single +/− branching | 21 | 13% | 150 | 11% | ||
Multiple vessels, focal | 26 | 16% | 214 | 16% | ||
Multiple vessels, multifocal | 57 | 36% | 519 | 39% | ||
Scattered vessels | 28 | 18% | 168 | 13% | ||
Circular | 1 | 1% | 1 | 0% | ||
Endometrial thickness (mm) | 14 | 10–23 | 17 | 10–26 | 0.132 | not significant |
Tumor volume (cm3) | 7.3 | 2.4–23.3 | 7.9 | 2.7–21.1 | 0.786 ε | not significant |
Finding | Premenopausal Women | Postmenopausal Women | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Low risk | Intermediate/high risk | Low risk | Intermediate/high risk | |||||||||
Sonographic findings, all women | N | % | N | % | Uncorrected p-value | Significance after Benjamini–Yekutieli procedure | N | % | N | % | Uncorrected p-value | Significance after Benjamini–Yekutieli procedure |
Tumor | 0.196 | not significant | <0.001 | significant | ||||||||
Defined | 89 | 71% | 29 | 83% | 509 | 80% | 648 | 87% | ||||
Not defined | 37 | 29% | 6 | 17% | 127 | 20% | 93 | 93% | ||||
BMI | 0.696 | not significant | <0.001 | significant | ||||||||
<30 | 77 | 61% | 23 | 66% | 338 | 53% | 473 | 64% | ||||
≥30 | 49 | 39% | 12 | 34% | 298 | 47% | 268 | 36% | ||||
Waist group | 1.000 | not significant | 0.001 | significant | ||||||||
<80 cm | 49 | 39% | 13 | 37% | 146 | 23% | 229 | 31% | ||||
≥80 cm | 77 | 61% | 22 | 63% | 490 | 77% | 512 | 69% | ||||
Sonographic findings, in women w. visible endometrium only | ||||||||||||
Endometrial–myometrial border | <0.001 | significant | <0.001 | significant | ||||||||
Regular | 58 | 46% | 3 | 9% | 207 | 33% | 91 | 13% | ||||
Non-regular | 68 | 54% | 29 | 91% | 415 | 67% | 606 | 87% | ||||
Endometrial echogenicity | 0.232 | not significant | <0.001 | significant | ||||||||
Uniform | 55 | 44% | 10 | 31% | 266 | 43% | 230 | 33% | ||||
Non-uniform | 71 | 56% | 22 | 69% | 356 | 57% | 467 | 67% | ||||
Endometrial midline | 0.818 | not significant | 0.431 | not significant | ||||||||
Seen | 29 | 23% | 8 | 25% | 74 | 12% | 73 | 10% | ||||
Undefined/not seen | 97 | 77% | 24 | 75% | 548 | 88% | 624 | 90% | ||||
Color score | 0.156 | not significant | <0.001 | significant | ||||||||
No flow–minimal flow | 49 | 39% | 8 | 25% | 324 | 52% | 189 | 27% | ||||
Moderate flow–abundant flow | 77 | 61% | 24 | 75% | 298 | 48% | 508 | 73% | ||||
Vascular pattern | 0.216 | not significant | <0.001 | significant | ||||||||
All others | 84% | 67% | 17 | 53% | 449 | 72% | 351 | 50% | ||||
Multiple vessels, multifocal | 42 | 33% | 15 | 47% | 173 | 28% | 346 | 50% |
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Green, R.W.; Fischerová, D.; Testa, A.C.; Franchi, D.; Frühauf, F.; Lindqvist, P.G.; di Legge, A.; Cibula, D.; Fruscio, R.; Haak, L.A.; et al. Sonographic, Demographic, and Clinical Characteristics of Pre- and Postmenopausal Women with Endometrial Cancer; Results from a Post Hoc Analysis of the IETA4 (International Endometrial Tumor Analysis) Multicenter Cohort. Diagnostics 2024, 14, 1. https://doi.org/10.3390/diagnostics14010001
Green RW, Fischerová D, Testa AC, Franchi D, Frühauf F, Lindqvist PG, di Legge A, Cibula D, Fruscio R, Haak LA, et al. Sonographic, Demographic, and Clinical Characteristics of Pre- and Postmenopausal Women with Endometrial Cancer; Results from a Post Hoc Analysis of the IETA4 (International Endometrial Tumor Analysis) Multicenter Cohort. Diagnostics. 2024; 14(1):1. https://doi.org/10.3390/diagnostics14010001
Chicago/Turabian StyleGreen, Rasmus W., Daniela Fischerová, Antonia C. Testa, Dorella Franchi, Filip Frühauf, Pelle G. Lindqvist, Alessia di Legge, David Cibula, Robert Fruscio, Lucia A. Haak, and et al. 2024. "Sonographic, Demographic, and Clinical Characteristics of Pre- and Postmenopausal Women with Endometrial Cancer; Results from a Post Hoc Analysis of the IETA4 (International Endometrial Tumor Analysis) Multicenter Cohort" Diagnostics 14, no. 1: 1. https://doi.org/10.3390/diagnostics14010001
APA StyleGreen, R. W., Fischerová, D., Testa, A. C., Franchi, D., Frühauf, F., Lindqvist, P. G., di Legge, A., Cibula, D., Fruscio, R., Haak, L. A., Opolskiene, G., Vidal Urbinati, A. M., Timmerman, D., Bourne, T., van den Bosch, T., & Epstein, E. (2024). Sonographic, Demographic, and Clinical Characteristics of Pre- and Postmenopausal Women with Endometrial Cancer; Results from a Post Hoc Analysis of the IETA4 (International Endometrial Tumor Analysis) Multicenter Cohort. Diagnostics, 14(1), 1. https://doi.org/10.3390/diagnostics14010001