Revisiting the paradigm: Asymptomatic high-grade endometrial cancer diagnosis is not associated with improved outcomes

Objective: To compare the survival of women with high grade endometrial cancer between asymptomatic and women presenting bleeding symptoms. Design: An Israel Gynecologic Oncology Group multi-center retrospective cohort study. Methods: The study included women who underwent surgery for high-grade endometrial cancer. We compared outcomes between women presenting with postmenopausal bleeding and asymptomatic women diagnosed with high-grade endometrial cancer. Recurrence-free, disease-specific and overall survival were assessed using the Kaplan Meier method and compared using the log-rank test. Risk factors for recurrence and death were evaluated using Cox regression analysis; the primary exposure variable assessed was the presence of postmenopausal bleeding. Results: Of the 584 women with high-grade histology, 498 (85.3 %) presented with postmenopausal bleeding and 86 (14.7 %) were asymptomatic. The median follow-up was 52 months (12–120 months). There was no difference in recurrence-free survival between women diagnosed with postmenopausal bleeding and asymptomatic women (70.1 % vs.64.6 % at 5 years, p = 0.35, respectively). There were no significant differences in disease-specific survival (66.3 % vs. 64.2 % at 5 years, p = 0.83) or in overall survival (56.4 % vs. 58 % at five years, p = 0.55) between study groups. The multivariate Cox regression analysis did not reveal any significant association between postmenopausal bleeding and survival. Conclusion: In this study, the diagnosis of high-grade endometrial cancer in asymptomatic women was not associated with earlier disease stage at diagnosis. In women with incidental ultrasonographic findings of a thickened endometrium or polyp, routine invasive evaluation may be unnecessary.