From the Department of Medical Sciences, University of Brasilia, Brasilia, Brazil; Department of Obstetrics and Gynecology, University Hospital of Brasília, Brasilia, Brazil.
From the Department of Medical Sciences, University of Brasilia, Brasilia, Brazil.
J Minim Invasive Gynecol. 2018 Jul-Aug;25(5):777-785. doi: 10.1016/j.jmig.2018.02.004. Epub 2018 Feb 14.
In this study, we aimed to estimate the frequency of premalignant and malignant lesions in endometrial polyps, and to evaluate associated clinical and demographic factors. A literature search was performed in major databases and the gray literature using the terms polyps OR endometrial polyp AND endometrial neoplasms OR endometrial cancer OR endometrial hyperplasia OR malignan*. Studies describing the frequency of premalignant and malignant lesions in endometrial polyps and any clinical or demographic factors associated with malignant lesions extracted using hysteroscopy were considered eligible. Independent investigators selected the studies and extracted the data. A meta-analysis was performed using a random-effects model and meta-regression. We identified 37 studies (comprising 21,057 patients) of endometrial polyps. The prevalence of premalignant and malignant lesions was 3.4% (95% confidence interval [CI], 2.8-4.1; I, 80.5%). Abnormal uterine bleeding (prevalence ratio [PR], 1.47; 95% CI, 1.27-1.69; I, 82.4%), menopausal status (PR, 1.67; 95% CI, 1.48-1.89; I, 78.4%), age >60 years (PR, 2.41; 95% CI, 1.84-3.16; I, 81.5%), diabetes mellitus (PR, 1.76; 95% CI, 1.43-2.16; I, 0.0%), systemic arterial hypertension (PR, 1.50; 95% CI, 1.20-1.88; I, 75.9%), obesity (PR, 1.41; 95% CI:1.13-1.76; I, 41.2%), and tamoxifen use (PR, 1.53; 95% CI, 1.06-2.21; I, 0.0%) were associated with endometrial polyp malignancy. However, breast cancer (PR, 0.83; 95% CI, 0.44-1.57; I, 0.0%), hormonal therapy (PR, 0.93; 95% CI, 0.67-1.30; I, 31.7%), parity (PR, 0.87; 95% CI, 0.39-1.96; I, 78.1%), and endometrial polyp size (PR, 1.05; 95% CI, 0.70-1.57; I, 44.7%) were not associated with malignancy of endometrial polyps. Three of every 100 women with clinically recognized polyps, a condition associated with specific clinical and demographic factors, will harbor premalignant or malignant lesions.
在这项研究中，我们旨在估计子宫内膜息肉中癌前病变和恶性病变的频率，并评估相关的临床和人口统计学因素。我们在主要数据库和灰色文献中使用术语息肉或子宫内膜息肉和子宫内膜肿瘤或子宫内膜癌或子宫内膜增生或恶性肿瘤进行了文献检索。符合条件的研究是描述子宫内膜息肉中癌前病变和恶性病变的频率，以及与恶性病变相关的任何临床或人口统计学因素，并使用宫腔镜提取这些因素。独立调查人员选择了研究并提取了数据。我们使用随机效应模型和荟萃回归进行了荟萃分析。我们确定了 37 项研究（包括 21057 名患者），涉及子宫内膜息肉。癌前病变和恶性病变的患病率为 3.4%（95%置信区间[CI]，2.8-4.1；I 为 80.5%）。异常子宫出血（患病率比[PR]，1.47；95%CI，1.27-1.69；I，82.4%）、绝经状态（PR，1.67；95%CI，1.48-1.89；I，78.4%）、年龄>60 岁（PR，2.41；95%CI，1.84-3.16；I，81.5%）、糖尿病（PR，1.76；95%CI，1.43-2.16；I，0.0%）、全身性动脉高血压（PR，1.50；95%CI，1.20-1.88；I，75.9%）、肥胖（PR，1.41；95%CI：1.13-1.76；I，41.2%）和他莫昔芬使用（PR，1.53；95%CI，1.06-2.21；I，0.0%）与子宫内膜息肉恶性肿瘤相关。然而，乳腺癌（PR，0.83；95%CI，0.44-1.57；I，0.0%）、激素治疗（PR，0.93；95%CI，0.67-1.30；I，31.7%）、产次（PR，0.87；95%CI，0.39-1.96；I，78.1%）和子宫内膜息肉大小（PR，1.05；95%CI，0.70-1.57；I，44.7%）与子宫内膜息肉的恶性程度无关。每 100 名患有临床可识别息肉的女性中，就有 3 名患有癌前病变或恶性病变，这种情况与特定的临床和人口统计学因素有关。
