Barzilai Medical Center, Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel.
Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Am J Obstet Gynecol. 2018 Aug;219(2):181.e1-181.e6. doi: 10.1016/j.ajog.2018.05.013. Epub 2018 May 21.
Incidental ultrasonographic findings in asymptomatic postmenopausal women, such as thickened endometrium or polyps, often lead to invasive procedures and to the occasional diagnosis of endometrial cancer. Data supporting a survival advantage of endometrial cancer diagnosed prior to the onset of postmenopausal bleeding are lacking.
To compare the survival of asymptomatic and bleeding postmenopausal patients diagnosed with endometrial cancer.
This was an Israeli Gynecology Oncology Group retrospective multicenter study of 1607 postmenopausal patients with endometrial cancer: 233 asymptomatic patients and 1374 presenting with postmenopausal bleeding. Clinical, pathological, and survival measures were compared.
There was no significant difference between the asymptomatic and the postmenopausal bleeding groups in the proportion of patients in stage II-IV (23.5% vs 23.8%; P = .9) or in high-grade histology (41.0% vs 38.4%; P = .12). Among patients with stage-I tumors, asymptomatic patients had a greater proportion than postmenopausal bleeding patients of stage IA (82.1% vs 66.2%; P < .01) and a smaller proportion received adjuvant postoperative radiotherapy (30.5% vs 40.6%; P = .02). There was no difference between asymptomatic and postmenopausal bleeding patients in the 5-year recurrence-free survival (79.1% vs 79.4%; P = .85), disease-specific survival (83.2% vs 82.2%; P = .57), or overall survival (79.7% vs 76.8%; P = .37).
Endometrial cancer diagnosed in asymptomatic postmenopausal women is not associated with higher survival rates. Operative hysteroscopy/curettage procedures in asymptomatic patients with ultrasonographically diagnosed endometrial polyps or thick endometrium are rarely indicated. It is reasonable to reserve these procedures for patients whose ultrasonographic findings demonstrate significant change over time.
无症状绝经后妇女的超声偶然发现，如子宫内膜增厚或息肉，常导致侵入性操作和偶尔诊断为子宫内膜癌。缺乏支持绝经后出血前诊断的子宫内膜癌生存优势的数据。
比较无症状和出血性绝经后患者诊断为子宫内膜癌的生存情况。
这是以色列妇科肿瘤学组的一项回顾性多中心研究，纳入 1607 例绝经后子宫内膜癌患者：233 例无症状患者和 1374 例绝经后出血患者。比较了临床、病理和生存指标。
无症状组和绝经后出血组 II-IV 期患者的比例（23.5%比 23.8%；P=0.9）或高级别组织学的比例（41.0%比 38.4%；P=0.12）无显著差异。在 I 期肿瘤患者中，无症状患者比绝经后出血患者更倾向于 IA 期（82.1%比 66.2%；P<.01），且术后辅助放疗的比例较小（30.5%比 40.6%；P=0.02）。无症状和绝经后出血患者的 5 年无复发生存率（79.1%比 79.4%；P=0.85）、疾病特异性生存率（83.2%比 82.2%；P=0.57）或总生存率（79.7%比 76.8%；P=0.37）无差异。
无症状绝经后妇女诊断的子宫内膜癌与更高的生存率无关。对于超声诊断为子宫内膜息肉或子宫内膜增厚的无症状患者，行宫腔镜/刮宫术的操作很少有必要。对于超声表现随时间显著变化的患者，保留这些操作是合理的。
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