Neuwirth Robert S, Loffer Franklin D, Trenhaile Therese, Levin Bruce
Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital Center, 1000 Tenth Avenue, New York, NY 10019, USA.
J Am Assoc Gynecol Laparosc. 2004 Nov;11(4):492-4. doi: 10.1016/s1074-3804(05)60081-3.
To assess the incidence of endometrial cancer in 509 women who had undergone hysteroscopic endometrial ablation in two centers between 1978 and 1994. All patients had normal endometrial histology before ablation.
Retrospective cohort study (Canadian Task Force classification II-2).
Teaching hospital-affiliated private practices.
Five hundred nine women with perimenopausal bleeding.
The patients were contacted directly, by mail or phone, and asked if they had had a diagnosis or treatment for cancer or precancer of the endometrium. The list of unreachable patients was submitted to the National Death Index. After this, names and other pertinent data of the remaining patients were submitted to the Cancer Registries of the 50 states and Washington, DC. Forty-two patients were omitted from these searches due to insufficient information or because they were unreachable, and one excluded because of a diagnosis of Bloom's syndrome. The comparative incidence was obtained from the U.S. SEER data of age-specific rates of endometrial cancer published by the National Cancer Institute.
Fifty-one percent of the patients were contacted directly yielding one case of endometrial cancer. Eight patients had died, but none from endometrial cancer. One patient was located in the New Jersey Cancer Registry. A total of 5063 woman-years was identified with two cases of endometrial cancer. The expected incidence was 1.66 cases in an age-matched group with known length of follow-up from the U.S. SEER data. There is no significant difference between the two groups.
The flaws in the databases include the lack of data on subsequent hysterectomy for benign disease in both the treated group and the SEER database. Low risk for endometrial cancer is narrowly defined to normal endometrium preablation. Nevertheless, the data give an approximation of the incidence for endometrial cancer, and should serve as a benchmark for prospective studies in patients undergoing endometrial ablation as well as a resource to counsel patients in the choice between ablation and hysterectomy.
评估1978年至1994年间在两个中心接受宫腔镜子宫内膜切除术的509名女性中子宫内膜癌的发病率。所有患者在切除术前子宫内膜组织学均正常。
回顾性队列研究（加拿大工作组分类II-2）。
教学医院附属的私人诊所。
509名围绝经期出血的女性。
通过邮件或电话直接联系患者，询问她们是否被诊断出患有子宫内膜癌或癌前病变，或是否接受过相关治疗。无法联系到的患者名单被提交至国家死亡索引。在此之后，其余患者的姓名和其他相关数据被提交至50个州及华盛顿特区的癌症登记处。由于信息不足或无法联系到，42名患者被排除在这些搜索之外，1名患者因被诊断为布卢姆综合征而被排除。比较发病率来自美国国家癌症研究所公布的美国监测、流行病学和最终结果（SEER）数据中按年龄划分的子宫内膜癌发病率。
51%的患者被直接联系上，发现1例子宫内膜癌。8名患者已死亡，但均非死于子宫内膜癌。1名患者被列入新泽西州癌症登记处。共确定了5063人年，其中有2例子宫内膜癌。根据美国SEER数据中已知随访时长的年龄匹配组，预期发病率为1.66例。两组之间无显著差异。
数据库中的缺陷包括治疗组和SEER数据库中均缺乏关于随后因良性疾病进行子宫切除术的数据。子宫内膜癌的低风险被狭义地定义为切除术前子宫内膜正常。尽管如此，这些数据给出了子宫内膜癌发病率的近似值，应为接受子宫内膜切除术患者的前瞻性研究提供基准，并为患者在切除术和子宫切除术之间的选择提供咨询参考。
