PDF(Pubmed)
Abstract：
OBJECTIVE: To compare long-term risk of reintervention across four uterus-preserving surgical treatments for leiomyomas and to assess effect modification by sociodemographic factors in a prospective cohort study in an integrated health care delivery system.
METHODS: We studied a cohort of 10,324 patients aged 18-50 (19.9% Asian, 21.2% Black, 21.3% Hispanic, 32.5% White, 5.2% additional races and ethnicities) who had a first uterus-preserving procedure (abdominal, laparoscopic, or vaginal myomectomy [referred to as myomectomy]; hysteroscopic myomectomy; endometrial ablation; uterine artery embolization) after leiomyoma diagnosis in the 2009-2021 electronic health records of Kaiser Permanente Northern California. We followed up patients until reintervention (second uterus-preserving procedure or hysterectomy) or censoring. We used a Kaplan-Meier estimator to calculate the cumulative incidence of reintervention and Cox regression models to estimate hazard ratios and 95% CIs comparing rates of reintervention across procedures, adjusting for age, parity, race and ethnicity, body mass index (BMI), Neighborhood Deprivation Index, and year. We also assessed effect modification by demographic characteristics.
RESULTS: Median follow-up was 3.8 years (interquartile range 1.8-7.4 years). Index procedures were 18.0% (1,857) hysteroscopic myomectomies, 16.2% (1,669) uterine artery embolizations, 21.4% (2,211) endometrial ablations, and 44.4% (4,587) myomectomies. Accounting for censoring, the 7-year reintervention risk was 20.6% for myomectomy, 26.0% for uterine artery embolization, 35.5% for endometrial ablation, and 37.0% for hysteroscopic myomectomy; 63.2% of reinterventions were hysterectomies. Within each procedure type, reintervention rates did not vary by BMI, race and ethnicity, or Neighborhood Deprivation Index. However, rates of reintervention after uterine artery embolization, endometrial ablation, and hysteroscopic myomectomy decreased with age, and reintervention rates for hysteroscopic myomectomy were higher for parous than nulliparous patients.
CONCLUSIONS: Long-term reintervention risks for uterine artery embolization, endometrial ablation, and hysteroscopic myomectomy are greater than for myomectomy, with potential variation by patient age and parity but not BMI, race and ethnicity, or Neighborhood Deprivation Index.
METHODS: We studied a cohort of 10,324 patients aged 18-50 (19.9% Asian, 21.2% Black, 21.3% Hispanic, 32.5% White, 5.2% additional races and ethnicities) who had a first uterus-preserving procedure (abdominal, laparoscopic, or vaginal myomectomy [referred to as myomectomy]; hysteroscopic myomectomy; endometrial ablation; uterine artery embolization) after leiomyoma diagnosis in the 2009-2021 electronic health records of Kaiser Permanente Northern California. We followed up patients until reintervention (second uterus-preserving procedure or hysterectomy) or censoring. We used a Kaplan-Meier estimator to calculate the cumulative incidence of reintervention and Cox regression models to estimate hazard ratios and 95% CIs comparing rates of reintervention across procedures, adjusting for age, parity, race and ethnicity, body mass index (BMI), Neighborhood Deprivation Index, and year. We also assessed effect modification by demographic characteristics.
RESULTS: Median follow-up was 3.8 years (interquartile range 1.8-7.4 years). Index procedures were 18.0% (1,857) hysteroscopic myomectomies, 16.2% (1,669) uterine artery embolizations, 21.4% (2,211) endometrial ablations, and 44.4% (4,587) myomectomies. Accounting for censoring, the 7-year reintervention risk was 20.6% for myomectomy, 26.0% for uterine artery embolization, 35.5% for endometrial ablation, and 37.0% for hysteroscopic myomectomy; 63.2% of reinterventions were hysterectomies. Within each procedure type, reintervention rates did not vary by BMI, race and ethnicity, or Neighborhood Deprivation Index. However, rates of reintervention after uterine artery embolization, endometrial ablation, and hysteroscopic myomectomy decreased with age, and reintervention rates for hysteroscopic myomectomy were higher for parous than nulliparous patients.
CONCLUSIONS: Long-term reintervention risks for uterine artery embolization, endometrial ablation, and hysteroscopic myomectomy are greater than for myomectomy, with potential variation by patient age and parity but not BMI, race and ethnicity, or Neighborhood Deprivation Index.
摘要：
目的：在一项综合医疗服务系统的前瞻性队列研究中，比较4种子宫肌瘤保留手术再干预的长期风险，并评估社会人口统计学因素对治疗效果的影响。
方法：我们研究了10,324名年龄在18-50岁的患者（19.9％的亚洲人，21.2%黑色,21.3%西班牙裔，32.5%白色,5.2％的额外种族和种族）进行了第一次子宫保留手术（腹部，腹腔镜,或阴道子宫肌瘤切除术[称为子宫肌瘤切除术]；宫腔镜子宫肌瘤切除术；子宫内膜消融；子宫动脉栓塞）在2009-2021年北加利福尼亚KaiserPermanente电子健康记录中诊断为平滑肌瘤后。我们对患者进行随访，直到再次干预（第二次保留子宫手术或子宫切除术）或审查。我们使用Kaplan-Meier估计器来计算再干预的累积发生率，并使用Cox回归模型来估计风险比和95％CIs比较不同程序的再干预率。调整年龄，奇偶校验，种族和民族,体重指数（BMI），邻里剥夺指数,和年份。我们还通过人口统计学特征评估了效果改变。
结果：中位随访时间为3.8年（四分位距1.8-7.4年）。指数程序为18.0％（1,857）宫腔镜子宫肌瘤切除术，16.2%(1669)子宫动脉栓塞,21.4%(2,211)子宫内膜消融,和44.4%(4,587)的子宫肌瘤切除术。审查会计，子宫肌瘤切除术的7年再干预风险为20.6%,子宫动脉栓塞术占26.0%，子宫内膜消融术占35.5%，宫腔镜子宫肌瘤剔除术占37.0%;再次干预的63.2%为子宫切除术。在每种程序类型中，再干预率不因BMI而异，种族和民族,或者邻里剥夺指数.然而,子宫动脉栓塞后的再干预率，子宫内膜消融,宫腔镜子宫肌瘤切除术随着年龄的增长而减少，宫腔镜下子宫肌瘤切除术的再干预率高于未产妇。
结论：子宫动脉栓塞的长期再干预风险，子宫内膜消融,宫腔镜子宫肌瘤切除术比子宫肌瘤切除术要多，随着患者年龄和胎次的潜在变化，而不是BMI，种族和民族,或者邻里剥夺指数.
方法：我们研究了10,324名年龄在18-50岁的患者（19.9％的亚洲人，21.2%黑色,21.3%西班牙裔，32.5%白色,5.2％的额外种族和种族）进行了第一次子宫保留手术（腹部，腹腔镜,或阴道子宫肌瘤切除术[称为子宫肌瘤切除术]；宫腔镜子宫肌瘤切除术；子宫内膜消融；子宫动脉栓塞）在2009-2021年北加利福尼亚KaiserPermanente电子健康记录中诊断为平滑肌瘤后。我们对患者进行随访，直到再次干预（第二次保留子宫手术或子宫切除术）或审查。我们使用Kaplan-Meier估计器来计算再干预的累积发生率，并使用Cox回归模型来估计风险比和95％CIs比较不同程序的再干预率。调整年龄，奇偶校验，种族和民族,体重指数（BMI），邻里剥夺指数,和年份。我们还通过人口统计学特征评估了效果改变。
结果：中位随访时间为3.8年（四分位距1.8-7.4年）。指数程序为18.0％（1,857）宫腔镜子宫肌瘤切除术，16.2%(1669)子宫动脉栓塞,21.4%(2,211)子宫内膜消融,和44.4%(4,587)的子宫肌瘤切除术。审查会计，子宫肌瘤切除术的7年再干预风险为20.6%,子宫动脉栓塞术占26.0%，子宫内膜消融术占35.5%，宫腔镜子宫肌瘤剔除术占37.0%;再次干预的63.2%为子宫切除术。在每种程序类型中，再干预率不因BMI而异，种族和民族,或者邻里剥夺指数.然而,子宫动脉栓塞后的再干预率，子宫内膜消融,宫腔镜子宫肌瘤切除术随着年龄的增长而减少，宫腔镜下子宫肌瘤切除术的再干预率高于未产妇。
结论：子宫动脉栓塞的长期再干预风险，子宫内膜消融,宫腔镜子宫肌瘤切除术比子宫肌瘤切除术要多，随着患者年龄和胎次的潜在变化，而不是BMI，种族和民族,或者邻里剥夺指数.
