据报道,50岁及以上女性的子宫内膜活检中有15%的子宫内膜增生。与子宫内膜增生相反,增殖性子宫内膜与子宫内膜癌的风险无关。
本研究旨在报告绝经后女性子宫内膜增生的长期结局。
这是一项回顾性队列研究,对1997年1月至2008年12月期间接受子宫内膜取样的1808名55岁及以上女性进行了研究。结果数据截至2018年2月。将子宫内膜增生的妇女与子宫内膜萎缩的妇女进行比较,以了解子宫内膜增生或癌症的未来发展。对绝经后出血的患者进行了亚分析。使用单变量和多变量逻辑回归分析来评估混杂因素。
在这项研究中,297名妇女(16.4%)接受了增生性子宫内膜的诊断。此外,962名妇女符合纳入标准。在这些女性中,278子宫内膜增生,684例子宫内膜萎缩性。子宫内膜增生的女性年龄较小(61.2vs64.5岁;P<.0001),体重指数较高(33.9vs30.6kg/m2;P<.0001)。更多的非洲裔美国女性子宫内膜增生。两组的监测时间相似(11.9vs11.5年;P=0.27)。子宫内膜增生的女性患子宫内膜增生或癌症的风险更高(11.9%vs2.9%;P<0.0001),任何子宫内膜癌(5.8%vs1.8%;P=0.002),不典型子宫内膜增生(2.2%vs0.4%;P=.02),与非非典型子宫内膜增生(2.0%vs0.7%;P=.001)。在排除激素替代疗法的病例后,发生子宫内膜癌和子宫内膜增生的风险仍然相似(12.2%vs3%;P=.001)。在逻辑回归分析中,增生性子宫内膜组织学(比值比,3.89;95%置信区间,2.03-7.49;P<.0001),年龄>60岁(赔率比,1.98;95%置信区间,1.03-3.82;P=.04),和体重指数>35公斤/平方米(赔率比,2.3;95%置信区间,1.09-4.83;P<0.0001)仍然是进展为癌症的重要危险因素。
接受子宫内膜取样的6名绝经后妇女中有1名子宫内膜增生。此外,11.9%的女性出现子宫内膜增生或癌症,发病率是子宫内膜萎缩性妇女的4倍。这项研究的结果表明,对于绝经后出血和子宫内膜增生性组织学的女性,需要长期监测。需要进一步的研究来检查是否需要治疗来消除无相反雌激素的风险。
Proliferative endometrium has been reported in 15% of endometrial biopsies of women aged 50 years and older. Contrary to endometrial hyperplasia, proliferative endometrium has not been associated with the risk of endometrial cancer.
This study aimed to report on the long-term outcome of postmenopausal women who received a diagnosis of proliferative endometrium.
This is a retrospective cohort study of 1808 women aged 55 years and older who underwent endometrial sampling between January 1997 and December 2008. Outcome data were available through February 2018. Women with a proliferative endometrium were compared with those with an atrophic endometrium for future development of endometrial hyperplasia or cancer. A subanalysis was performed for those who presented with postmenopausal bleeding. Uni- and multivariable logistic regression analyses were used to assess for confounders.
In this study, 297 women (16.4%) received a diagnosis of proliferative endometrium. Furthermore, 962 women met the inclusion criteria. Among those women, 278 had a proliferative endometrium, and 684 had an atrophic endometrium. Women with a proliferative endometrium were younger (61.2 vs 64.5 years; P<.0001) and had a higher body mass index (33.9 vs 30.6 kg/m2; P<.0001). More African American women had a proliferative endometrium. Both groups had a similar length of surveillance (11.9 vs 11.5 years; P=.27). Women with a proliferative endometrium had a higher risk of developing endometrial hyperplasia or cancer (11.9% vs 2.9%; P<.0001), any endometrial cancer (5.8% vs 1.8%; P=.002), atypical endometrial hyperplasia (2.2% vs 0.4%; P=.02), and nonatypical endometrial hyperplasia (2.0% vs 0.7%; P=.001). The risk of developing endometrial cancer and endometrial hyperplasia remained similar after excluding cases on hormonal replacement therapy (12.2% vs 3%; P=.001). On logistic regression analysis, proliferative endometrium histology (odds ratio, 3.89; 95% confidence interval, 2.03-7.49; P<.0001), age >60 years (odds ratio, 1.98; 95% confidence interval, 1.03-3.82; P=.04), and body mass index >35 kg/m2 (odds ratio, 2.3; 95% confidence interval, 1.09-4.83; P<.0001) remained significant risk factors for progression to cancer.
One of the 6 postmenopausal women who underwent endometrial sampling had a proliferative endometrium. Furthermore, 11.9% of women developed endometrial hyperplasia or cancer, a 4-fold greater incidence than women with an atrophic endometrium. The findings of this study suggest that long-term monitoring is warranted for women with postmenopausal bleeding and a proliferative endometrium histology. Further studies are needed to examine if a treatment is required to negate the risk of unopposed estrogen.