Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hyvinkää, the Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, the Department of Obstetrics and Gynecology, Helsinki University Hospital, and the University of Helsinki, Helsinki, the Department of Obstetrics and Gynecology, Turku University Hospital, and the University of Turku, Turku, the Faculty of Medicine and Life Sciences, University of Tampere, the Department of Obstetrics and Gynecology, Tampere University Hospital, and the Faculty of Social Sciences, University of Tampere, Tampere, and the National Institute for Health and Welfare, Department of Information Services, Helsinki, Finland; and the Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden.
Obstet Gynecol. 2017 Sep;130(3):554-560. doi: 10.1097/AOG.0000000000002166.
To study the risk of endometrial cancer and breast cancer and the hysterectomy rate after endometrial ablation.
In this retrospective cohort study, records of all women with endometrial ablation at ages 30-49 years in Finland (1997-2014) were extracted from the Hospital Discharge Register and linked to the Cancer Registry and Finnish Central Population Register. The primary outcome was cancer incidences in the endometrial ablation cohort compared with those in the background population of the same age. Secondarily, the postablation hysterectomy rate was compared with that of a control cohort of similar-aged women extracted from the Finnish Central Population Register. Multivariate regression models with adjustment for age, parity, number of cesarean deliveries, history of sterilization, and the duration of follow-up were evaluated as risk factors for postablation hysterectomy.
In total, 154 cancers (standardized incidence ratio [observed-to-expected ratio] 0.96, 95% CI 0.82-1.13) were diagnosed among 5,484 women treated with endometrial ablation during the follow-up of 39,892 women-years. The standardized incidence ratio for endometrial cancer was 0.56 (95% CI 0.12-1.64) and for breast cancer 0.86 (95% CI 0.67-1.09). A total of 1,086 (19.8%) women had postablation hysterectomy. Risk of hysterectomy was almost fourfold in the endometrial ablation cohort compared with 26,938 women in a control group (adjusted hazard ratio [HR] 3.63, 95% CI 3.32-3.96). Factors predisposing to postablation hysterectomy were leiomyomas (adjusted HR 1.78, 95% CI 1.03-3.10), age younger than 35 years (adjusted HR 1.44, 95% CI 1.15-1.81), at least two prior cesarean deliveries (adjusted HR 1.27, 95% CI 1.04-1.55), and history of sterilization (adjusted HR 1.15, 95% CI 1.01-1.32).
Endometrial ablation was not associated with an elevated endometrial cancer or breast cancer risk in Finland. Leiomyomas, young age, and history of prior cesarean deliveries or sterilization were associated with an increased risk of postablation hysterectomy.
研究子宫内膜消融术后子宫内膜癌和乳腺癌的发病风险以及子宫切除术率。
本回顾性队列研究从芬兰的住院患者登记系统中提取了年龄在 30-49 岁之间接受子宫内膜消融术的所有女性的记录，并与癌症登记系统和芬兰中央人口登记系统进行了链接。主要结局是比较子宫内膜消融组与同期年龄相匹配的背景人群的癌症发病率。其次，将消融术后的子宫切除术率与从芬兰中央人口登记系统中提取的年龄相匹配的对照组进行比较。通过多变量回归模型，调整年龄、产次、剖宫产次数、绝育史和随访时间等因素，评估这些因素是否为消融术后子宫切除术的危险因素。
在 39892 名女性年的随访期间，共诊断出 5484 名接受子宫内膜消融术的女性中发生了 154 例癌症（标准化发病比[观察到的与预期的比值]0.96，95%CI0.82-1.13）。子宫内膜癌的标准化发病比为 0.56（95%CI0.12-1.64），乳腺癌为 0.86（95%CI0.67-1.09）。共有 1086 名（19.8%）女性在消融术后行子宫切除术。与对照组中 26938 名女性相比，子宫内膜消融组的子宫切除术风险几乎增加了 4 倍（调整后的危险比[HR]3.63，95%CI3.32-3.96）。导致消融术后子宫切除术的因素包括子宫肌瘤（调整后的 HR1.78，95%CI1.03-3.10）、年龄小于 35 岁（调整后的 HR1.44，95%CI1.15-1.81）、至少两次剖宫产（调整后的 HR1.27，95%CI1.04-1.55）和绝育史（调整后的 HR1.15，95%CI1.01-1.32）。
在芬兰，子宫内膜消融术与子宫内膜癌或乳腺癌的发病风险升高无关。子宫肌瘤、年龄较小、既往剖宫产史或绝育史与消融术后子宫切除术风险增加相关。
