Sadia Anjum, Anas Tahseen, Aqueel Shahid, Tabinda Sadaf, Anusha Haider, Abdul Subhan, Rameesha Jahangir, Fajar Rafi Ranjha
Key prognostic factors in EC, including age, stage, nodal involvement, histology, and performance status, are consistent with international and Asian data. Regional differences in age at diagnosis, obesity prevalence, and histologic distribution highlight the need for context-specific management strategies in LMICs. Prospective studies incorporating molecular profiling may further refine risk stratification and improve outcomes.
INTRODUCTION: Endometrial carcinoma (EC) is a common gynecologic malignancy with rising incidence globally, including in low- and middle-income countries. Local data on clinicopathological characteristics, treatment patterns, and survival outcomes remain limited in Pakistan.
MATERIALS AND METHODS: This retrospective cohort study included 622 women aged ≥18 years with histologically confirmed EC treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre between 2010 and 2020. Clinical, pathological, treatment, and outcome data were extracted from the institutional electronic medical records. Survival outcomes were estimated using Kaplan-Meier analysis, and prognostic factors were evaluated using Cox proportional hazards regression. Statistical analyses were conducted using IBM SPSS Statistics 27.0. The study was approved by the Institutional Review Board of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan (IRB exemption number EX-17-12-25-01).
RESULTS: The median age was 56 years (range 24-87), and 36.3% were aged ≥60 years. Mean BMI was 32.8 kg/m2, reflecting a high prevalence of obesity. Most patients presented with FIGO stage I disease (71.4%), and deep myometrial invasion (≥50%) was present in 47.7%. Nodal metastasis was identified in 5.8%. Primary surgical treatment was performed in 94.4% of patients, with frequent use of adjuvant radiotherapy (57.2%), brachytherapy (60.6%), and chemotherapy (83.6%). The 5-year overall survival (OS) was 88.6% (95% CI: 85.6-91.7). On multivariate analysis, FIGO stage, nodal status, age and BMI were independent predictors of Overall Survival (OS).
CONCLUSION: Key prognostic factors in EC, including age, stage, nodal involvement, histology, and performance status, are consistent with international and Asian data. Regional differences in age at diagnosis, obesity prevalence, and histologic distribution highlight the need for context-specific management strategies in LMICs. Prospective studies incorporating molecular profiling may further refine risk stratification and improve outcomes.