复杂性增生伴不伴非典型：孕激素治疗的临床结局和意义。
Complex hyperplasia with and without atypia: clinical outcomes and implications of progestin therapy.
机构信息
From the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center; the Departments of Obstetrics and Gynecology, Epidemiology, and Pathology, University of Washington, Seattle, Washington; and Group Health Research Institute, Seattle, Washington.
出版信息
Obstet Gynecol. 2010 Aug;116(2 Pt 1):365-373. doi: 10.1097/AOG.0b013e3181e93330.
OBJECTIVE
Limited data exist to inform clinicians and patients as to the likelihood of long-term endometrial hyperplasia response to progestin therapy, especially for atypical hyperplasia. We evaluated women with complex and atypical endometrial hyperplasia, comparing those prescribed progestin with those not prescribed progestin.
METHODS
This retrospective cohort study was conducted in 1985-2005 among women aged 18-88 years at an integrated health plan in Washington State. Women were ineligible if they achieved an outcome (endometrial carcinoma, hysterectomy, or both) within 8 weeks of hyperplasia diagnosis. Exposure was progestin use for at least 14 days by duration and recency. Outcomes included rate of 1) endometrial carcinoma, 2) hysterectomy, or 3) both. Analyses performed included Kaplan-Meier, incident rate ratios, and Cox proportional hazard ratios.
RESULTS
One thousand four hundred forty-three eligible women were identified. One thousand two hundred one had complex (n=164 no progestin) and 242 had atypical (n=62 no progestin) hyperplasia. During follow-up, a median of 5.3 years (range 8 weeks to 20.8 years), 71 women were diagnosed with endometrial carcinoma (35 complex, 36 atypia) and 323 underwent hysterectomy (216 complex, 107 atypia). Among women with complex and atypical hyperplasia, rates of endometrial carcinoma among progestin users were 3.6 and 20.5 per 1,000 woman-years, respectively (compared with women who did not use progestin, 10.8 and 101.4). Among women with complex and atypical hyperplasia, rates of hysterectomy among progestin users were 23.3 and 61.4 per 1,000 woman-years, respectively (compared with women who did not use progestin, 55.1 and 297.3).
CONCLUSION
Endometrial carcinoma risk is diminished approximately threefold to fivefold in women diagnosed with complex or atypical endometrial hyperplasia and dispensed progestin; hysterectomy risk is also decreased.
LEVEL OF EVIDENCE
II.
目的
目前有关孕激素治疗后长期子宫内膜增生反应的可能性的信息，尤其是针对非典型性增生，能够提供给临床医生和患者的信息十分有限。我们评估了患有复杂性和非典型性子宫内膜增生的女性，并比较了接受孕激素治疗和未接受孕激素治疗的患者。
方法
这是一项回顾性队列研究，于 1985 年至 2005 年在华盛顿州一家综合性医疗保健计划中进行，研究对象为年龄在 18 至 88 岁之间的女性。如果患者在子宫内膜增生诊断后 8 周内出现结局（子宫内膜癌、子宫切除术或两者兼有），则不符合入选条件。暴露是指至少使用 14 天孕激素，根据使用时间和近期情况进行分类。结局包括以下 3 种情况的发生率：1）子宫内膜癌，2）子宫切除术，或 3）两者兼有。进行的分析包括 Kaplan-Meier 分析、发病率比值和 Cox 比例风险比。
结果
共确定了 1443 名符合条件的女性。121 名女性患有复杂性子宫内膜增生（164 名未接受孕激素治疗），242 名女性患有非典型性子宫内膜增生（62 名未接受孕激素治疗）。在随访期间，中位随访时间为 5.3 年（8 周至 20.8 年），71 名女性被诊断为子宫内膜癌（35 名复杂性，36 名非典型性），323 名女性接受了子宫切除术（216 名复杂性，107 名非典型性）。在患有复杂性和非典型性子宫内膜增生的女性中，孕激素使用者的子宫内膜癌发生率分别为每 1000 名妇女 3.6 和 20.5 例（与未使用孕激素的女性相比，发生率分别为 10.8 和 101.4）。在患有复杂性和非典型性子宫内膜增生的女性中，孕激素使用者的子宫切除术发生率分别为每 1000 名妇女 23.3 和 61.4 例（与未使用孕激素的女性相比，发生率分别为 55.1 和 297.3）。
结论
患有复杂性或非典型性子宫内膜增生并接受孕激素治疗的女性，其子宫内膜癌风险降低约 3 倍至 5 倍；子宫切除术风险也降低。
证据水平
II 级。
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