Ørbo Anne, Arnes Marit, Hancke Christine, Vereide Anne Beate, Pettersen Inger, Larsen Kurt
Department of Pathology, University Hospital of Tromsø, N-9038 Tromsø, Norway.
Gynecol Oncol. 2008 Oct;111(1):68-73. doi: 10.1016/j.ygyno.2008.06.014. Epub 2008 Aug 6.
Three different treatment options for endometrial hyperplasia were evaluated in a prospective long-time follow-up study, comparing effects of intrauterine levonorgestrel impregnated device (LNG-IUD), low oral dose of medroxyprogesterone acetate (MPA) and no treatment (observation only). To select patients with high probability for co-existing or future carcinoma we used the objective morphometric algorithm, D-score, stratifying patients into three different risk groups. As far as we know, this is the first prospective long-time follow-up study in which treatment recommendation and outcome is based on the D-score assessment.
From a total of 370 patients initially diagnosed with endometrial hyperplasia from eight different hospitals in North Norway, 258 were available for long-time follow-up. After D-score classification, one of three different treatment options was chosen: LNG-IUD, low oral dose of MPA or observation only. Follow-up controls were performed and biopsies taken in the local hospitals.
Among the 370 investigated cases with endometrial hyperplasia, only ten endometrial cancers were detected at the entrance of the study, all belonging to the high risk group (D-score <0). No further cancers were detected during follow-up, irrespective of risk group. After 6 months treatment with LNG-IUD proved significantly superior to oral treatment (p=0.001 for D-score >1 and p=0.003 for D-score 0-1 groups) and observation only (p=0.001 for D-score >1 and p=0.001 for D-score 0-1 groups). After 56 to 108 months the LNG-IUD proved significantly superior to oral treatment and to the observation group. Comparison of oral therapy to observation only showed no significant differences, neither after 6 months nor after long-time observation.
LNG-IUD is the optimal treatment for endometrial hyperplasia. Outcome after oral low-dose MPA regimen is comparable to expectation.
在一项前瞻性长期随访研究中评估子宫内膜增生的三种不同治疗方案，比较宫内左炔诺孕酮缓释系统（LNG - IUD）、低剂量口服醋酸甲羟孕酮（MPA）及不治疗（仅观察）的效果。为选择存在或未来发生癌症可能性高的患者，我们使用客观形态计量学算法D评分，将患者分为三个不同风险组。据我们所知，这是第一项基于D评分评估进行治疗推荐和观察结果的前瞻性长期随访研究。
从挪威北部八家不同医院最初诊断为子宫内膜增生的370例患者中，258例可进行长期随访。在进行D评分分类后，选择三种不同治疗方案之一：LNG - IUD、低剂量口服MPA或仅观察。在当地医院进行随访控制并取活检。
在370例接受调查的子宫内膜增生病例中，研究开始时仅检测到10例子宫内膜癌，均属于高危组（D评分<0）。随访期间未检测到更多癌症，无论风险组如何。使用LNG - IUD治疗6个月后，其效果显著优于口服治疗（D评分>1时p = 0.001，D评分0 - 1组时p = 0.003）和仅观察（D评分>1时p = 0.001，D评分0 - 1组时p = 0.001）。56至108个月后，LNG - IUD的效果显著优于口服治疗和观察组。口服治疗与仅观察相比，6个月后及长期观察后均无显著差异。
LNG - IUD是子宫内膜增生的最佳治疗方法。低剂量口服MPA方案治疗后的结果与预期相当。
