Manopausal hormonal therapy and clinical and morphological features of endometrial cancer in women with metabolic disorders

Objective: To study clinical and morphological features of endometrial cancer in postmenopausal women with obesity (BMII≥30 kg/m2) depending on the use of menopausal hormone therapy (MHT). Materials and methods: A prospective study included 214 postmenopausal patients with verified endometrial cancer. The patients underwent surgical treatment in the Department of Gynecology of the Medical and Rehabilitation Center, Ministry of Health of Russia and in the Department of Oncogynecology in the University Clinical Hospital No. 4 of I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, in the period 2019-2021. The stage of uterine cancer was diagnosed in accordance with TNM classification (UICC, the 8th edition, 2016) and international FIGO classification (2009). Endometrial cancer (EC) was differentiated by grades: G1 - well differentiated; G2 - moderately differentiated; G3 - poorly differentiated cancer. The main group included 140postmenopausal women with BMII≥30 kg/m2; 58patients took hormonal therapy (HT). The comparison group comprised 74 women without cancer with BMI 17.6-24.9 kg/m2, including 20 patients receiving HT. All patients used estrogen/gestagen combination preparations for 12 months and longer. Results: Endometrial cancer with myometrial invasion less than 50% (Т1а according to TNM classification (UICC, the 8th edition, 2016) was found signif icantly more often in the subgroup of women with normal body weight, while later stages of EC with advanced invasion were significantly more often in the main group of women with obesity (p=0.012). Assessment of differentiation grades also demonstrated significant differences: in the comparison group the rate of well differentiated EC (G1) was significantly higher compared with the main group, where moderately differentiated EC was observed more often (p=0.001). The comparative analysis of the studied parameters in the subgroups of women who did not take HT, showed no significant differences (р=0.383; р=0.745). Conclusion: The study demonstrated that in the subgroup of patients with obesity, who used HT, the incidence of later stages of moderately and poorly differentiated (G2-G3) EC was significantly higher. The results of the study proved importance of BMI monitoring and timely correction of hormonal-metabolic disorders in menopausal women prior to HT, aimed both to reduce EC rates, and to minimize the risk of development of later stages of moderately and poorly differentitated EC.

endometrial cancer, endometrial adenocarcinoma, menopausal hormonal therapy, obesity