Department of Obstetrics and Gynecology, Osaka Saiseikai Nakatsu Hospital, Osaka, 530-0012, Japan.
Department of Gynecology, Osaka International Cancer Institute, 3-1-69, Otemae, Osaka, 541-8567, Japan.
Int J Clin Oncol. 2024 Jul;29(7):1027-1034. doi: 10.1007/s10147-024-02511-5. Epub 2024 May 19.
We aimed to investigate the trends in the incidence and treatment of endometrial cancer (EC) during potentially reproductive age in Japan, with a special focus on the relative oncologic safety of hormonal therapy (HT) over surgery.
This population-based retrospective cohort study was conducted using data from the Osaka Cancer Registry from 2004 to 2018. Women with EC were first identified and then distributions of age, stage, histology, and initial treatment were examined. Then, the relative oncologic safety of HT over surgery in patients under the age of 50 years was evaluated.
Among the 9417 patients with EC, 1937 were diagnosed during their potentially reproductive age (< 50 years). The incidence of EC during potentially reproductive age has increased from 18.5% in 2004-2011 to 21.9% in 2012-2018. ECs during potentially reproductive age more frequently displayed favorable characteristics, such as endometrioid histology, and lower histological grade than those in non-potentially reproductive age. Among the 1223 patients diagnosed with localized endometrioid EC, 74 cases (6.0%) received HT as an initial treatment, while 1100 cases (90.0%) underwent surgery as their initial treatment. When the two treatment groups were compared, there was no significant difference in overall survival (p = 0.3713). The estimated 5-year survival rates were 100 and 98.8% in the HT and surgery groups, respectively.
EC is increasingly diagnosed during potentially reproductive age in Japan. The use of HT as an initial treatment is increasing, and achieved comparable survival outcomes to urgery against localized endometrioid EC during the potentially reproductive age.
本研究旨在探讨日本生育年龄期子宫内膜癌（EC）的发病和治疗趋势，并特别关注激素治疗（HT）相对于手术的相对肿瘤安全性。
本基于人群的回顾性队列研究使用了 2004 年至 2018 年大阪癌症登记处的数据。首先确定了患有 EC 的女性，然后检查了年龄、分期、组织学和初始治疗的分布情况。然后，评估了 50 岁以下患者中 HT 相对于手术的相对肿瘤安全性。
在 9417 例 EC 患者中，1937 例诊断为生育年龄期（<50 岁）。生育年龄期 EC 的发病率从 2004-2011 年的 18.5%增加到 2012-2018 年的 21.9%。生育年龄期 EC 更常表现出有利的特征，如子宫内膜样组织学和较低的组织学分级，而非生育年龄期 EC 则不然。在 1223 例局部子宫内膜样 EC 患者中，74 例（6.0%）接受 HT 作为初始治疗，而 1100 例（90.0%）接受手术作为初始治疗。比较这两组患者时，总体生存率无显著差异（p=0.3713）。HT 和手术组的估计 5 年生存率分别为 100%和 98.8%。
日本生育年龄期 EC 的诊断率呈上升趋势。HT 作为初始治疗的应用正在增加，并且在生育年龄期针对局限性子宫内膜样 EC 的治疗中取得了与手术相当的生存结果。
