TY - JOUR
T1 - Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia
AU - Lacey, James V.
AU - Sherman, Mark E.
AU - Rush, Brenda B.
AU - Ronnett, Brigitte M.
AU - Ioffe, Olga B.
AU - Duggan, Máire A.
AU - Glass, Andrew G.
AU - Richesson, Douglas A.
AU - Chatterjee, Nilanjan
AU - Langholz, Bryan
PY - 2010/2/10
Y1 - 2010/2/10
N2 - Purpose: The severity of endometrial hyperplasia (EH) - simple (SH), complex (CH), or atypical (AH) - influences clinical management, but valid estimates of absolute risk of clinical progression to carcinoma are lacking. Materials and Methods: We conducted a case-control study nested in a cohort of 7,947 women diagnosed with EH (1970-2002) at one prepaid health plan who remained at risk for at least 1 year. Patient cases (N = 138) were diagnosed with carcinoma, on average, 6 years later (range, 1 to 24 years). Patient controls (N = 241) were matched to patient cases on age at EH, date of EH, and duration of follow-up, and they were counter-matched to patient cases on EH severity. After we independently reviewed original slides and medical records of patient controls and patient cases, we combined progression relative risks (AH v SH, CH, or disordered proliferative endometrium [ie, equivocal EH]) from the case-control analysis with clinical censoring information (ie, hysterectomy, death, or left the health plan) on all cohort members to estimate interval-specific (ie, 1 to 4, 5 to 9, and 10 to 19 years) and cumulative (ie, through 4, 9, and 19 years) progression risks. Results: For nonatypical EH, cumulative progression risk increased from 1.2% (95% CI, 0.6% to 1.9%) through 4 years to 1.9% (95% CI, 1.2% to 2.6%) through 9 years to 4.6% (95% CI, 3.3% to 5.8%) through 19 years after EH diagnosis. For AH, cumulative risk increased from 8.2% (95% CI, 1.3% to 14.6%) through 4 years to 12.4% (95% CI, 3.0% to 20.8%) through 9 years to 27.5% (95% CI, 8.6% to 42.5%) through 19 years after AH. Conclusion: Cumulative 20-year progression risk among women who remain at risk for at least 1 year is less than 5% for nonatypical EH but is 28% for AH.
AB - Purpose: The severity of endometrial hyperplasia (EH) - simple (SH), complex (CH), or atypical (AH) - influences clinical management, but valid estimates of absolute risk of clinical progression to carcinoma are lacking. Materials and Methods: We conducted a case-control study nested in a cohort of 7,947 women diagnosed with EH (1970-2002) at one prepaid health plan who remained at risk for at least 1 year. Patient cases (N = 138) were diagnosed with carcinoma, on average, 6 years later (range, 1 to 24 years). Patient controls (N = 241) were matched to patient cases on age at EH, date of EH, and duration of follow-up, and they were counter-matched to patient cases on EH severity. After we independently reviewed original slides and medical records of patient controls and patient cases, we combined progression relative risks (AH v SH, CH, or disordered proliferative endometrium [ie, equivocal EH]) from the case-control analysis with clinical censoring information (ie, hysterectomy, death, or left the health plan) on all cohort members to estimate interval-specific (ie, 1 to 4, 5 to 9, and 10 to 19 years) and cumulative (ie, through 4, 9, and 19 years) progression risks. Results: For nonatypical EH, cumulative progression risk increased from 1.2% (95% CI, 0.6% to 1.9%) through 4 years to 1.9% (95% CI, 1.2% to 2.6%) through 9 years to 4.6% (95% CI, 3.3% to 5.8%) through 19 years after EH diagnosis. For AH, cumulative risk increased from 8.2% (95% CI, 1.3% to 14.6%) through 4 years to 12.4% (95% CI, 3.0% to 20.8%) through 9 years to 27.5% (95% CI, 8.6% to 42.5%) through 19 years after AH. Conclusion: Cumulative 20-year progression risk among women who remain at risk for at least 1 year is less than 5% for nonatypical EH but is 28% for AH.
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U2 - 10.1200/JCO.2009.24.1315
DO - 10.1200/JCO.2009.24.1315
M3 - Article
C2 - 20065186
AN - SCOPUS:77649205666
SN - 0732-183X
VL - 28
SP - 788
EP - 792
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 5
ER -