Pattern of high-risk histopathological features among surgically treated endometrial cancer patients in Bangladesh

Farhana Rahman; Sarwar Mahboob; Mohammad Mozammal Huq; Saiful Islam

doi:10.18203/2320-1770.ijrcog20263972

Authors

Farhana Rahman Department of Gynaecological Oncology, Mughda Medical College and Hospital, Dhaka, Bangladesh
Sarwar Mahboob Department of Community Medicine and Public Health, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
Mohammad Mozammal Huq Department of Community Medicine and Public Health, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
Saiful Islam Department of Community Medicine and Public Health, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20263972

Keywords:

Endometrial cancer, Histopathology, High-risk features, Lymphovascular space invasion

Abstract

Background: Endometrial cancer shows heterogeneous biological behavior, and postoperative risk stratification depends strongly on histopathological findings. Conventional features such as International Federation of Gynecology and Obstetrics (FIGO) stage, tumor grade, histological subtype, tumor size, deep myometrial invasion, lymphovascular space invasion, and lymph node metastasis remain clinically important, particularly in settings where molecular classification is not routinely available. The aim of this study was to describe the pattern of high-risk histopathological features among surgically treated endometrial cancer patients at a tertiary cancer center in Bangladesh.

Methods: This observational cross-sectional study included 31 histologically confirmed endometrial cancer patients who underwent primary surgical treatment at the Department of Gynecological Oncology, National Institute of Cancer Research and Hospital, Dhaka, Bangladesh, between January and December 2020.

Results: The mean age of the patients was 58.6±9.8 years, and 27 patients (87.1%) were postmenopausal. Stage I disease was the most frequent individual stage, present in 18 patients (58.1%); however, advanced-stage disease, FIGO stage III–IV, was present in 12 patients (38.7%). The most frequent high-risk feature was tumor size >2 cm, observed in 21 patients (67.7%), followed by deep myometrial invasion in 16 patients (51.6%). Lymph node metastasis was present in 12 patients (38.7%), grade 3 tumor in 11 patients (35.5%), papillary serous adenocarcinoma in 11 patients (35.5%), and lymphovascular space invasion in 9 patients (29.0%).

Conclusions: High-risk histopathological features were common in this cohort, emphasizing the importance of detailed histopathological assessment for postoperative risk stratification in surgically treated endometrial cancer.

References

Berek JS, Matias-Guiu X, Creutzberg C, Fotopoulou C, Gaffney D, Kehoe S, et al. FIGO staging of endometrial cancer: 2023. J Gynecol Oncol. 2023;34(5):e85.

de Biase D, Maloberti T, Corradini AG, Rosini F, Grillini M, Ruscelli M, et al. Integrated clinicopathologic and molecular analysis of endometrial carcinoma: prognostic impact of the new ESGO-ESTRO-ESP endometrial cancer risk classification and proposal of histopathologic algorithm for its implementation in clinical practice. Front Med (Lausanne). 2023;10:1146499.

Jin X, Shen C, Yang X, Yu Y, Wang J, Che X. Association of tumor size with myometrial invasion, lymphovascular space invasion, lymph node metastasis, and recurrence in endometrial cancer: a meta-analysis of 40 studies with 53,276 patients. Front Oncol. 2022;12:881850.

Wang J, Xu P, Yang X, Yu Q, Xu X, Zou G, et al. Association of myometrial invasion with lymphovascular space invasion, lymph node metastasis, recurrence, and overall survival in endometrial cancer: a meta-analysis of 79 studies with 68,870 patients. Front Oncol. 2021;11:762329.

Kim SI, Yoon JH, Lee SJ, Song MJ, Kim JH, Lee HN, et al. Prediction of lymphovascular space invasion in patients with endometrial cancer. Int J Med Sci. 2021;18(13):2828-34.

Oliver-Perez MR, Padilla-Iserte P, Arencibia-Sanchez O, Martin-Arriscado C, Muruzabal JC, Diaz-Feijóo B, et al. Lymphovascular space invasion in early-stage endometrial cancer (LySEC): patterns of recurrence and predictors. A multicentre retrospective cohort study of the Spain Gynecologic Oncology Group. Cancers (Basel). 2023;15(9):2612.

Dai Y, Dong Y, Cheng Y, Hou H, Wang J, Wang Z, et al. Prognostic significance of lymphovascular space invasion in patients with endometrioid endometrial cancer: a retrospective study from a single center. J Gynecol Oncol. 2020;31(3):e27.

Li X, Cheng Y, Dong Y, Zhou J, Wang Z, Li X, et al. Development and validation of predictive model for lymph node metastasis in endometrial cancer: a SEER analysis. Ann Transl Med. 2021;9(7):538.

Han L, Chen Y, Zheng A, Tan X. Paraaortic lymph node metastasis in endometrial cancer patients: a comprehensive analysis of rates, survival outcomes, and risk factors through systematic review and meta-analysis. Front Oncol. 2024;14:1490347.

Olatunde OA, Samaila MO, Imam MI, Uchime KE, Dauda SE. Histopathological patterns of endometrial carcinoma in a tertiary hospital in North-West Nigeria. ecancermedicalscience. 2024;18:1651.

Sultana S, Khatun S, Begum SA, Amatullah M, Mahmud T, Faruq M, et al. Association between lymphovascular space invasion and preoperative CA-125 antigen and fibrinogen in patients with endometrial carcinoma. Bangladesh Med Res Counc Bull. 2024;50(1):40-7.

Khanam S, Akter S, Akter N, Khatun R, Shahriar MS, Ferdous MS. Evaluation of prognostic factors in patients with endometrial cancer. Sch Int J Obstet Gynec. 2024;7(12):671-7.

Wannasin R, Thinkhamrop K, Kelly M, Likitdee N. Evaluating the prognostic factors and survival rates of endometrial cancer patients in a tertiary referral hospital in Northeast Thailand. Asian Pac J Cancer Prev. 2024;25(2):671-9.

Pandey M, Acharya BC, Subedi H, Gurung SR, Pariyar J, Paudel S, et al. Study on endometrial cancer patients and their treatment outcome in BPKMCH. Europasian J Med Sci. 2021;3(2):60-4.

Pradhan R, Roy Biswas R, Mondal S, Mukherjee U. Immunohistochemical diversity of endometrial carcinoma and their implications in prognosis: a prospective clinicopathological study in a tertiary care hospital of Eastern India. J Obstet Gynaecol India. 2025;75(Suppl 1):166-72.

Yalcin Y, Kosan B, Yalcin S, Abay M, Ozerkan K. The impact of lymphovascular space invasion on recurrence and survival in FIGO stage I node-negative endometrioid endometrial cancer. J Clin Med. 2025;14(18):6535.