Clinical Characteristics and Treatment Outcomes of Patients With Endometrial Cancer in Kenyatta National Hospital, 2012-2018

Abstract

Background: Globally, endometrial cancer (EMC) is among the commonest gynecological malignancies occurring in women. The global age-standardized incidence rate of endometrial cancers is 8.2 per 100,000 while the death rate is 1.8 per 100,000. Although lower incidences of EMC are reported in India and African countries compared to Europe and North America, this has been partly attributed to under surveillance. In Kenya, there is lack of data on the characteristics of patients diagnosed with EMC, their management, and outcomes. Aim of the Study: To evaluate the clinical characteristics and treatment outcomes of patients managed for EMC at Kenyatta National Hospital (KNH), 2012 -2018. Methodology: A descriptive cohort study was conducted in the medical records department at Kenyatta National Hospital using data from patients’ files using a pre-approved data collection tool. The hospital files of all women with histologically confirmed endometrial cancer, managed at KNH between 2012 and 2018 were reviewed and data on demographic characteristics, clinical presentation, treatment modalities, treatment outcomes, and duration of survival collected. Where possible, participants were contacted by telephone to obtain missing data. Version 24 of the statistical package for social scientists’ software was used to analyse data. Summary statistics were computed and presented as frequencies, percentages, and means with standard deviation. The Kaplan Meier analysis method was used to evaluate the two-year and five-year cumulative survival rates. Results: Data of 68 women was reviewed. The mean age of participants was 63 (range 37-87) years. A majority were unemployed (56.9%), had primary education (54.5%), married (61.5%)and resided in Nairobi County (38.2%). The predominant comorbidities were chronic hypertension (57.4%) and diabetes (25%). Vaginal bleeding after menopause was the commonest presenting symptom (80.9%), followed by abdominal pain (38.2%) and vaginal discharge (26.5%). Endometroid adenocarcinoma (68.2%), mostly at grade 2 (55.9%) and stage I (26.7%), was the commonest histological subtype. A majority underwent surgery (96.7%), predominantly the total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) (83.1%). The remission, recurrence, and mortality rate among the participants were 66.7%, 30.6%, and 28.4%, respectively. The survival rates were 75.8% at two years and 72.8% at five years. Conclusion: Women with endometrial cancer seen at KNH have a good prognosis. Endometrial adenocarcinoma is the commonest histological subtype, with a majority presenting with postmenopausal vaginal bleeding and or discharge. TAH-BSO is the commonest treatment.