PDF(Pubmed)
Abstract：
BACKGROUND: Recurrent postmenopausal bleeding (PMB) occurs in 6%-25% of postmenopausal women who have experienced a previous episode of PMB. The question of whether recurrent PMB leads to a higher risk of endometrial cancer (EC) in comparison to a single episode of PMB is, however, controversial. Furthermore, little is known about predictive factors for recurrent PMB.
METHODS: A multicenter prospective cohort study was conducted over a 5-year period in four hospitals in the Netherlands. Women with PMB undergoing endometrial sampling and aged 40 years and older were included. Occurrence of recurrent PMB was retrospectively determined. Primary outcomes included (1) the incidence of recurrent PMB and (2) differences in pathological findings between patients with a single episode vs recurrent PMB. Secondary outcomes included (1) the association between diagnosis of benign polyps at first PMB and pathological findings at recurrent PMB and (2) factors predictive for recurrent PMB.
RESULTS: A total of 437 women with PMB were included, of whom 360 were at risk of recurrent PMB. With a median follow-up of 61 months (IQR (Interquartile range) 44-73), 26.4% experienced recurrent PMB. Patients with recurrent PMB were more often diagnosed with benign polyps (34.7% vs. 25.1%, p-value 0.015) and less frequently with a malignancy (5.3% vs. 17.8%, p-value 0.015), compared to patients with a single episode of PMB. Benign polyps at initial PMB were not associated with a (pre)malignancy at recurrence (OR 4.16, 95% CI 0.75-23.03). Predictive factors for recurrent PMB included use of hormone replacement therapy (HRT) (OR 3.32, 95% CI 1.64-6.72), and benign polyps at initial PMB (OR 1.80, 95% CI 1.07-3.04).
CONCLUSIONS: Recurrent PMB is common in women with a previous episode of PMB. Compared to patients with a single episode of PMB, patients with recurrent PMB and benign histological outcomes at accurate workup during their first episode were less often diagnosed with malignancies and more frequently with benign polyps. Benign polyps at first PMB are predictive for recurrent PMB, but not for a higher risk of (pre)malignancy.
METHODS: A multicenter prospective cohort study was conducted over a 5-year period in four hospitals in the Netherlands. Women with PMB undergoing endometrial sampling and aged 40 years and older were included. Occurrence of recurrent PMB was retrospectively determined. Primary outcomes included (1) the incidence of recurrent PMB and (2) differences in pathological findings between patients with a single episode vs recurrent PMB. Secondary outcomes included (1) the association between diagnosis of benign polyps at first PMB and pathological findings at recurrent PMB and (2) factors predictive for recurrent PMB.
RESULTS: A total of 437 women with PMB were included, of whom 360 were at risk of recurrent PMB. With a median follow-up of 61 months (IQR (Interquartile range) 44-73), 26.4% experienced recurrent PMB. Patients with recurrent PMB were more often diagnosed with benign polyps (34.7% vs. 25.1%, p-value 0.015) and less frequently with a malignancy (5.3% vs. 17.8%, p-value 0.015), compared to patients with a single episode of PMB. Benign polyps at initial PMB were not associated with a (pre)malignancy at recurrence (OR 4.16, 95% CI 0.75-23.03). Predictive factors for recurrent PMB included use of hormone replacement therapy (HRT) (OR 3.32, 95% CI 1.64-6.72), and benign polyps at initial PMB (OR 1.80, 95% CI 1.07-3.04).
CONCLUSIONS: Recurrent PMB is common in women with a previous episode of PMB. Compared to patients with a single episode of PMB, patients with recurrent PMB and benign histological outcomes at accurate workup during their first episode were less often diagnosed with malignancies and more frequently with benign polyps. Benign polyps at first PMB are predictive for recurrent PMB, but not for a higher risk of (pre)malignancy.
摘要：
背景：在曾经历过PMB发作的绝经后妇女中，有6%-25%的人发生复发性绝经后出血（PMB）。与单次PMB相比，复发性PMB是否会导致子宫内膜癌（EC）的风险更高。然而,有争议。此外，对复发性PMB的预测因素知之甚少。
方法：在荷兰的四家医院进行了为期5年的多中心前瞻性队列研究。包括接受子宫内膜取样的PMB女性，年龄在40岁及以上。回顾性确定复发性PMB的发生。主要结果包括（1）复发性PMB的发生率和（2）单次发作与复发性PMB患者之间的病理结果差异。次要结果包括（1）首次PMB时良性息肉的诊断与复发性PMB的病理发现之间的关联，以及（2）预测复发性PMB的因素。
结果：共纳入437名患有PMB的女性，其中360人存在复发性PMB的风险。中位随访时间为61个月（IQR（四分位距）44-73），26.4%的PMB复发。复发性PMB患者更常被诊断为良性息肉（34.7%vs.25.1%,p值0.015)，恶性肿瘤的频率较低(5.3%vs.17.8%,p值0.015),与一次PMB发作的患者相比。初次PMB时的良性息肉与复发时的（前）恶性肿瘤无关（OR4.16，95％CI0.75-23.03）。PMB复发的预测因素包括使用激素替代疗法（HRT）（OR3.32，95％CI1.64-6.72），和良性息肉在初始PMB（OR1.80，95%CI1.07-3.04）。
结论：反复发生的PMB常见于先前发生过PMB的女性。与一次PMB发作的患者相比，在首次发作期间进行准确检查时,有复发性PMB和良性组织学结局的患者诊断为恶性肿瘤的频率较低,而良性息肉的频率较高.起初良性息肉是PMB复发的预测因素，但不是因为(前)恶性肿瘤的风险较高。
方法：在荷兰的四家医院进行了为期5年的多中心前瞻性队列研究。包括接受子宫内膜取样的PMB女性，年龄在40岁及以上。回顾性确定复发性PMB的发生。主要结果包括（1）复发性PMB的发生率和（2）单次发作与复发性PMB患者之间的病理结果差异。次要结果包括（1）首次PMB时良性息肉的诊断与复发性PMB的病理发现之间的关联，以及（2）预测复发性PMB的因素。
结果：共纳入437名患有PMB的女性，其中360人存在复发性PMB的风险。中位随访时间为61个月（IQR（四分位距）44-73），26.4%的PMB复发。复发性PMB患者更常被诊断为良性息肉（34.7%vs.25.1%,p值0.015)，恶性肿瘤的频率较低(5.3%vs.17.8%,p值0.015),与一次PMB发作的患者相比。初次PMB时的良性息肉与复发时的（前）恶性肿瘤无关（OR4.16，95％CI0.75-23.03）。PMB复发的预测因素包括使用激素替代疗法（HRT）（OR3.32，95％CI1.64-6.72），和良性息肉在初始PMB（OR1.80，95%CI1.07-3.04）。
结论：反复发生的PMB常见于先前发生过PMB的女性。与一次PMB发作的患者相比，在首次发作期间进行准确检查时,有复发性PMB和良性组织学结局的患者诊断为恶性肿瘤的频率较低,而良性息肉的频率较高.起初良性息肉是PMB复发的预测因素，但不是因为(前)恶性肿瘤的风险较高。
