Peddada Shyamal D, Laughlin Shannon K, Miner Kelly, Guyon Jean-Philippe, Haneke Karen, Vahdat Heather L, Semelka Richard C, Kowalik Ania, Armao Diane, Davis Barbara, Baird Donna Day
Biostatistics Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA.
Proc Natl Acad Sci U S A. 2008 Dec 16;105(50):19887-92. doi: 10.1073/pnas.0808188105. Epub 2008 Dec 1.
Uterine leiomyomata (fibroids) are the leading cause of hysterectomy in the United States. Black women have a greater fibroid burden than whites, yet no study has systematically evaluated the growth of fibroids in blacks and whites. We prospectively tracked growth for 262 fibroids (size range: 1-13 cm in diameter) from 72 premenopausal participants (38 blacks and 34 whites). Fibroid volume was measured by computerized analysis of up to four MRI scans over 12 months. We used mixed effects models to identify factors that are associated with growth, and results were converted to percent change per 6 months for clinical relevance. The median growth rate was 9% (range: -89% to +138%). Seven percent of fibroids regressed (>20% shrinkage). Tumors from the same woman grew at different rates (within-woman component of variation was twice the component among women; both were significant, P < 0.001). Black and white women less than 35 years of age had similar fibroid growth rates. However, growth rates declined with age for whites but not for blacks (P = 0.05). The odds of a tumor growing more than 20% in 6 months also decreased with age for whites but not for blacks (P < 0.01). Growth rates were not influenced by tumor size, location, body mass index, or parity. We conclude that (i) spontaneous regression of fibroids occurs; (ii) fibroids from the same woman grow at different rates, despite a uniform hormonal milieu; (iii) fibroid size does not predict growth rate; and (iv) age-related differences in fibroid growth between blacks and whites may contribute to the higher symptom burden for black women.
子宫平滑肌瘤（纤维瘤）是美国子宫切除的主要原因。黑人女性的纤维瘤负担比白人女性更重，但尚无研究系统评估黑人和白人纤维瘤的生长情况。我们前瞻性地追踪了72名绝经前参与者（38名黑人、34名白人）的262个纤维瘤（大小范围：直径1 - 13厘米）的生长情况。通过对12个月内最多4次MRI扫描进行计算机分析来测量纤维瘤体积。我们使用混合效应模型来确定与生长相关的因素，并将结果转换为每6个月的百分比变化以体现临床相关性。中位生长率为9%（范围：-89%至+138%）。7%的纤维瘤出现了消退（缩小超过20%）。同一女性体内的肿瘤生长速率不同（女性个体内部的变异成分是女性个体之间变异成分的两倍；两者均具有显著性，P < 0.001）。年龄小于35岁的黑人和白人女性的纤维瘤生长速率相似。然而，白人女性的生长速率随年龄下降，而黑人女性则不然（P = 0.05）。白人女性肿瘤在6个月内生长超过20%的几率也随年龄下降，而黑人女性则不然（P < 0.01）。生长速率不受肿瘤大小、位置、体重指数或产次的影响。我们得出以下结论：（i）纤维瘤会自然消退；（ii）尽管激素环境一致，但同一女性体内的纤维瘤生长速率不同；（iii）纤维瘤大小不能预测生长速率；（iv）黑人和白人女性在纤维瘤生长方面与年龄相关的差异可能导致黑人女性更高的症状负担。
