Synchronous primary cancers of the endometrium and ovary: review of 43 cases

Abstract

Objective

To investigate the clinical and pathological characteristics, treatment methods, and prognosis of synchronous primary cancer of the endometrium and ovary.

Methods

The clinical data of 43 patients with synchronous primary cancer of endometrium and ovary were retrospectively reviewed. The survival was calculated by Kaplan-Meier method and compared using the log-rank test.

Results

The median age of the patients at diagnosis was 49 years (range, 28–73 years). The most common symptoms were abnormal vaginal bleeding (69.8%) and abdominal or pelvic pain (44.2%). Pelvic masses were found in 39.5% of the patients and enlarged corpus in 27.9% at physic examination, while pelvic masses were found in 67.4% of the 43 patients (29 cases) and thickening or abnormal endometrium in 23.3% (10 cases) during ultrasound examination. Of 25 patients examined by CT/MRI, pelvic masses were found in 13 cases and enlarged uterus in 11 cases. All 15 patients who underwent endometrial biopsies were proven to have endometrioid carcinomas. Serum CA125 level was found to be elevated in 22 of the 34 examined cases (64.7%) with median value 500 U/mL (range, 39–3439 U/mL). FIGO stages of endometrial carcinomas: IA 18 cases, IB 20 cases, IC 2 cases, and IIA 3 cases; Stages of ovarian carcinomas: IA 19 case, IB 4 cases, IC 7 cases, II 4 cases, and IIIC 9 cases. Twenty-four patients (55.8%) were in stage I both endometrial and ovarian carcinomas. Thirty-one patients underwent total hysterectomy plus bilateral salpingo-oophorectomy with omentectomy and appendectomy, meanwhile, 12 patients had pelvic lymph nodes dissection. Thirty-eight of the 43 patients (88.4%) had a pathologically proven endometrial adenocarcinomas. The predominant ovarian histologies were endometrioid or mixed tumors with endometrioid components (30/43, 69.8%). Postoperatively, 26 patients (60.5%) received adjuvant chemotherapy alone, 12 had chemotherapy plus radiotherapy, only one patients had radiation alone and the remaining 4 cases received no adjuvant treatment. The 3-year and 5-year survival rates of the group were 87.4% and 71.1% respectively. The 3-year and 5-year survival rates of patients with endometrioid carcinoma at both endometrial and ovarian were higher than that of those with non-endometrioid or mixed histologic subtypes (93.8%, 82% vs 79.7%, 69%). The 3-year and 5-year survival rates of patients with early stages disease were better than those of other patients (93.3%, 93.3% vs 69.7%, 36.7%). Recurrence developed in 15 patients (34.9%). It was showed by univariate analysis that lower CA125 level, early FIGO stage, and adjuvant chemotherapy plus radiotherapy significantly and positively affected the 5-year survival rate, while only early FIGO stage and chemotherapy plus radiotherapy were revealed by multivariate analysis as independent prognostic factors.

Conclusion

Synchronous primary cancers of the endometrium and ovary were different from either the primary endometrial or ovarian cancer, while usually it can be detected in early stage with a good prognosis. The impact of the CA125 level on prognosis needs to be further studied. Surgery treatment alone may be enough for early stage patients. Chemotherapy plus radiotherapy may be necessary for advanced patients.