Endometrial Cancer in Brazil: Preparing for the Rising Incidence

Paulino, Eduardo; Nogueira-Rodrigues, Angélica; Goss, Paul E.; Faroni, Lilian; Guitmann, Gustavo; Strasser‐Weippl, Kathrin; Bukowski, Alexandra

doi:10.1055/s-0038-1673644

Cited by 11 publications

(11 citation statements)

References 16 publications

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“…The incidence is increasing worldwide due to the increasing rate of obesity and the aging of the population. 2 In Brazil, the incidence is higher in more developed areas, such as the Southeastern region, and is also expected to increase. 1 Type-II EC, such as the histologies analyzed in this cohort, has long been known for its poor prognosis, and multimodality treatment is usually recommended by major international guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…1 The worldwide incidence is expected to increase in upcoming years, since obesity and aging, which are important risk factors to develop EC, are increasing. 2 In 1983, Bohkman 3 performed a prospective study dividing EC into two major subgroups, in a classification that was used for decades. The first subgroup, named type I, was characterized by lower-grade histology, less aggressive behavior, metabolic syndrome, and a better response to progestins.…”

Section: Introductionmentioning

confidence: 99%

“…1 The worldwide incidence is expected to increase in upcoming years, since obesity and aging, which are important risk factors to develop EC, are increasing. 2…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics and Outcomes of a High-grade Endometrial Cancer Cohort Treated at Instituto Nacional de Câncer, Brazil

Paulino,

Melo

2023

Rev Bras Ginecol Obstet

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Objective To analyze the outcomes of a cohort of patients with high-risk histologies of endometrial cancer (EC) treated at Instituto Nacional de Câncer (National Cancer Institute, INCA, in Portuguese), in Brazil. Materials and Methods We reviewed the medical records of patients with high-risk histologies of EC in any stage registered at INCA between 2010 and 2016 to perform a clinical and demographic descriptive analysis and to evaluate the outcomes in terms of recurrence and survival. Results From 2010 to 2016, 2,145 EC patients were registered and treated at INCA, and 466 had high-grade histologies that met the inclusion criteria. The mean age of the patients was 65 years, 44.6% were Caucasian, and 90% had a performance status of 0 or 1. The most common histology was high-grade endometrioid (31.1%), followed by serous carcinoma (25.3%), mixed (20.0%), carcinosarcoma (13.5%), and clear cell carcinoma (9.4%). Considering the 2018 Fédération Internationale de Gynécologie et d'Obstétrique (International Federation of Gynecology and Obstetrics, FIGO, in French) staging system, 44.8%, 12.4%, 29.8%, and 12.9% of the patient were in stages I, II, III or IV respectively. Age (> 60 years), more than 50% of myoinvasion, higher stage, poor performance status, serous and carcinosarcoma histologies, and adjuvant treatment were independent factors associated with recurrence-free survival (RFS) and overall survival (OS) in the multivariate analysis. Conclusion The current findings reinforced the international data showing poor outcomes of these tumors, especially for serous and carcinosarcomas and tumors with advanced stages, with shorter survival and high recurrence rates in distant sites, independently of the FIGO stage. Adjuvant therapy was associated with better survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics and Outcomes of a High-grade Endometrial Cancer Cohort Treated at Instituto Nacional de Câncer, Brazil

Paulino,

Melo

2023

Rev Bras Ginecol Obstet

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“…Even though incidence rates for uterine cancer vary up to 10-fold across countries, and the highest rates are found in North America and Eastern and Northern Europe, incidence rates have been rising worldwide, and countries with historically lower rates have had the largest proportional increase in incidence ( 3 ). Although only 7,840 new cases of tumors of the uterine corpus have been estimated for Brazil in 2023 ( 4 ), this country had the third largest average annual percent increase (nearly 5%) in incidence in a recent worldwide survey ( 3 , 5 , 6 ). Reasons for the rising incidence of uterine tumors remain incompletely understood, but an ageing population, declines in the fertility rate and the increasing prevalence of obesity are likely to play a major role ( 1 , 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

Management of patients with recurrent/metastatic endometrial cancer: Consensus recommendations from an expert panel from Brazil

Andrade

Guimarães²,

Melo³

et al. 2023

Front. Oncol.

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BackgroundEndometrial cancer is of increasing concern in several countries, including Brazil, in part because of an ageing population, declines in fertility, and the increasing prevalence of obesity. Although endometrial tumors had lagged behind other cancer types in terms of treatment improvements, molecular characterization of these tumors is paving the way for novel therapies and an expansion of the therapeutic arsenal. We aimed to help medical oncologists who manage patients with recurrent or metastatic endometrial cancer in the Brazilian healthcare setting.MethodsThe panel, composed of 20 medical oncologists, convened in November 2021 to address 50 multiple-choice questions on molecular testing and treatment choices. We classified the level of agreement among panelists as (1) consensus (≥75% choosing the same answer), (2) majority vote (50% to <75%), or (3) less than majority vote (<50%).ResultsConsensus was present for 25 of the 50 questions, whereas majority vote was present for an additional 23 questions. Key recommendations include molecular testing for every patient with recurrent/metastatic endometrial cancer; choice of first-line treatment according to microsatellite instability and HER2, with the addition of programmed death ligand 1 (PD-L1) and hormone receptors (HRs) for second-line therapy; carboplatin and paclitaxel as the preferred option in first-line treatment of HER2-negative disease, with the addition of trastuzumab in HER2-positive disease; pembrolizumab plus lenvatinib as a key option in second line, regardless of HER2, PD-L1 or HRs; and various recommendations regarding treatment choice for patients with distinct comorbidities.ConclusionDespite the existing gaps in the current literature, the vast majority of issues addressed by the panel provided a level of agreement sufficient to inform clinical practice in Brazil and in other countries with similar healthcare environments.

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“…Endometrial cancer is the sixth most common cancer in women worldwide and the second most common gynecological cancer in Brazil. Its incidence is increasing, in Brazil [1] and worldwide, with 382,096 new cases and 89,929 deaths from the disease recorded in 2018 [2]. By 2030, the incidence of endometrial cancer is projected to increase by 55% over the number of cases recorded in 2010 in the USA [3].…”

Section: Introductionmentioning

confidence: 99%

Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes

et al. 2020

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Few reports have described the clinical and prognostic characteristics of endometrial cancer, which is increasing worldwide, in large patient series in Brazil. Our objective was to analyze the clinicopathological characteristics, prognostic factors, and outcomes of patients with endometrial cancer treated and followed at a tertiary Brazilian institution over a 10-year period.This retrospective study included 703 patients diagnosed with endometrial cancer who were treated at a public academic tertiary hospital between 2008 and 2018. The following parameters were analyzed: age at diagnosis, race, body mass index, serum CA125 level before treatment; histological type and grade, and surgical stage. Outcomes were reported relative to histological type, surgical staging, serum CA125, lymph-vascular space involvement (LVSI), and lymph-node metastasis. The median patient age at diagnosis was 63 (range, 27-93) years (6.4% were <50 years). Minimally invasive surgeries were performed in 523 patients (74.4%). Regarding histological grade, 468 patients (66.5%) had low-grade endometrioid histology and 449 patients (63.9%) had stage I tumors. Tumors exceeded 2.0 cm in 601 patients (85.5%). Lymphadenectomy was performed in 551 cases (78.4%). LVSI was present in 208 of the patients' tumors (29.5%). Ninety-three patients (13.2%) had recurrent tumors and 97 (13.7%) died from their malignant disease. The robust prognostic value of FIGO stage and

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Endometrial Cancer in Brazil: Preparing for the Rising Incidence

Cited by 11 publications

References 16 publications

Clinical Characteristics and Outcomes of a High-grade Endometrial Cancer Cohort Treated at Instituto Nacional de Câncer, Brazil

Clinical Characteristics and Outcomes of a High-grade Endometrial Cancer Cohort Treated at Instituto Nacional de Câncer, Brazil

Management of patients with recurrent/metastatic endometrial cancer: Consensus recommendations from an expert panel from Brazil

Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes

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