Synchronous primary endometrial and ovarian cancers coexist in approximately 10% of all females with ovarian cancer and in 5% of all females with endometrial cancer. These cancers are uncommon and often misdiagnosed as FIGO stage III of endometrial cancer or FIGO stage II of ovarian cancer (1
). In our study, the incidence was 3.08% in patients with endometrial cancer and 3.18% in patients with ovarian cancer. Our study was conducted in a single institution rather than multicenter analysis, the study only included cases with confirmed diagnosis of synchronous tumors and other conditions, such as primary endometrial cancer with ovarian metastasis and primary ovarian cancer with endometrial metastasis, were excluded.
Synchronous primary endometrial and ovarian cancers are unlike endometrial or ovarian cancer alone (6
). Pathologists have listed histological criteria to evaluate these tumors. Molecular profiling in synchronous endometrioid and ovarian cancers may aid in determining a differential diagnosis. Halperin et al
reported that 62.5% of synchronous primary endometrial and ovarian cancers can be classified by detection of ER and PR content and that 31.3% of synchronous primary endometrial and ovarian cancers can be identified by detecting Bcl-2 (6
The median age of patients with synchronous primary endometrial and ovarian cancers was 50 years, and the median age of those with endometrial cancer or ovarian cancer was 60 years, so the incidence age of primary carcinoma was lower. Previous studies have also reported a younger median age in patients with synchronous primary endometrial and ovarian cancers (7
). In a prospective series of 74 patients with simultaneously detected endometrial and ovarian cancers, the GOG reported a median age of 49 years. Synchronous primary endometrial and ovarian cancer patients are younger than those who develop endometrial or ovarian cancer alone. In our study, the median age of the patients at the time of diagnosis was 51 years (range, 29–71).
Obesity is a well-known risk factor for the development of endometrial cancer. In the study by Soliman et al
, 36% of patients (17/47) in the endometrioid/endometrioid group, 30% of patients (3/10) in the endometrioid/serous group and 40% of patients (2/5) in the endometrioid/clear cell group were obese (BMI >30) (7
). Nishimura et al
reported that the mean BMI of Japanese females with synchronous primary endometrial and ovarian cancers was 22.6±3.4 kg/m2
(range, 16–31) (8
), but the authors did not report the obesity rates. In the present study, the median BMI was 23.44 kg/m2
(range, 15.79–36.33), only 7 (16.3%) of the 43 patients were obese (BMI >28). Asian ethnicity may be correlated with a lower obesity rate.
The clinical symptom and sign of synchronous primary endometrial and ovarian cancers are similar to the independent endometrial and ovarian cancers. AUB and abdominal mass were the main symptoms. In accordance with the results described in the literature, the common presenting symptoms in the present study were AUB (65.12%), abdominal mass (25.58%), abdominal pain and abdominal fullness (39.53%).
Surgical treatment is the main treatment for endometrial and ovarian cancers. Synchronous primary endometrial and ovarian cancers are often misdiagnosed as FIGO stage III of endometrial cancer or FIGO stage II of ovarian cancer in early years, hence patients are often over-treated. Although cancer of both uterine body and that of the ovary occurs simultanenously, pathological changes are mainly of early stage. The scope of general surgery included hysterectomy, bilateral salpingo-oophorectomy, omentectomy and appendectomy. Pelvic lymph node dissection depended on the pathological findings (9
). The treatment of patients with ovarian cancer is generally based on chemotherapy with paclitaxel plus cisplatin (TP) regimen or cisplatin + doxorubicin + cyclophosphamide (PAC) regimen and the length of treatment ranges from 2 to 10 cycles, generally 3 to 6 cycles; however, patients with stage I or II grade 1 ovarian cancer do not require chemotherapy. In 1982, Eifel proposed that patients who have the following risk factors of endometrial cancer should receive adjuvant radiotherapy: i) pathological type of papillary serous adenocarcinoma or adenosquamous; ii) tumor differentiation as G2, G3 grade; iii) deep myometrial invasion.
However, the adjuvant treatment for these patients is controversial. In our study, surgical treatment was used for all patients; 6 patients underwent hysterectomy and bilateral salpingo-oophorectomy and the remaining 37 patients had total hysterectomy, bilateral salpingo-oophoretomy, omentectomy, appendectomy and pelvic lymph node dissection. The majority of patients received postoperative platinum-based chemotherapy. A total of 38 patients received adjuvant chemotherapy, 3 patients received both adjuvant chemotherapy and radiotherapy and 4 patients received neoadjuvant chemotherapy. It is difficult to evaluate the prognosis of these patients without consideration of the impact of adjuvant chemotherapy.
Our results showed that the mean survival in the group with early stage (I and II) disease was 109 months and the survival rate was 93.5%; the mean survival was 54 months in the group with advanced stage (III/IV) disease and the survival rate was 63.7%. There was a statistically significant difference between the groups (P=0.003 <0.05; ). The survival rate in the group of endometrioid carcinoma in the endometrium and ovaries was 94.1%, the survival rate in the group with mixed pathological type was 80.8% and the result was not significant (P= 0.197 >0.05; ). Ayhan et al
concluded that the stage of ovarian cancer and grade of endometrial cancer are important prognostic factors (4
). Our results indicated that the stage had a greater influence on the survival than the histology. We suggest that the advanced stage has a detrimental influence on survival and was a poor prognostic predicator in synchronous primary endometrial and ovarian cancers.