子宫内膜息肉患者的恶变风险及预测因素。

Risk and predictors of malignancy in women with endometrial polyps.

机构信息

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.

出版信息

Ann Surg Oncol. 2011 Dec;18(13):3819-23. doi: 10.1245/s10434-011-1815-z. Epub 2011 Jun 24.

DOI:10.1245/s10434-011-1815-z

PMID:21701931

Abstract

BACKGROUND

Endometrial polyps commonly affect premenopausal and postmenopausal women and carry a small risk of cancer. Consensus guidelines to direct the management of women with endometrial polyps are lacking. We examined the risk of malignancy in symptomatic and asymptomatic women with endometrial polyps.

METHODS

Institutional databases were analyzed to identify women with pathologically confirmed endometrial polyps diagnosed from 2002 to 2007. Demographic, clinical, and pathologic outcomes were reviewed. The most significant pathologic diagnosis was recorded for each subject. Endometrial hyperplasia and cancer were characterized as arising in the polyp or the adjacent endometrium. Factors associated with atypical hyperplasia and cancer were analyzed.

RESULTS

A total of 1011 women with endometrial polyps were identified. On pathology review, 964 (95.4%) polyps were reported as benign, 13 (1.3%) as hyperplasia without atypia, 5 (0.5%) as hyperplasia with atypia, and 13 (1.3%) as endometrial cancer. The only clinical or demographic factor associated with atypical hyperplasia and cancer was menopausal status (P = .02). Among premenopausal women the risk of cancer or atypical hyperplasia was 0.9% in patients without bleeding and 1.0% in women with bleeding. In postmenopausal women cancer or atypical hyperplasia was found in 1.9% of patients without bleeding and in 3.8% of women with bleeding.

CONCLUSIONS

The risk of endometrial cancer in women with endometrial polyps is 1.3%, while cancers confined to a polyp were found in only 0.3%. The risk is greatest in postmenopausal women with vaginal bleeding.

摘要

背景

子宫内膜息肉常见于绝经前和绝经后妇女，其癌变风险较小。目前缺乏指导子宫内膜息肉患者管理的共识指南。本研究旨在评估有症状和无症状的子宫内膜息肉患者发生恶变的风险。

方法

分析了 2002 年至 2007 年间经病理证实的子宫内膜息肉患者的机构数据库。对患者的人口统计学、临床和病理结果进行了回顾。记录了每位患者最主要的病理诊断。子宫内膜增生和癌症被定义为息肉内或邻近子宫内膜发生的病变。分析了与不典型增生和癌症相关的因素。

结果

共纳入 1011 例子宫内膜息肉患者。病理检查结果显示，964 例（95.4%）为良性息肉，13 例（1.3%）为不伴非典型性增生的单纯性增生，5 例（0.5%）为伴非典型性增生的单纯性增生，13 例（1.3%）为子宫内膜癌。仅绝经状态与不典型增生和癌症相关（P =.02）。在绝经前女性中，无出血症状患者的癌症或不典型增生风险为 0.9%，而有出血症状患者的风险为 1.0%。在绝经后女性中，无出血症状患者的癌症或不典型增生风险为 1.9%，而有出血症状患者的风险为 3.8%。