Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Canter, Bronx, New York, NY, USA.
Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA.
Ultrasound Obstet Gynecol. 2020 Apr;55(4):546-551. doi: 10.1002/uog.20421. Epub 2020 Feb 28.
To assess the long-term outcome of postmenopausal women diagnosed with non-atypical endometrial hyperplasia (NEH).
This was a retrospective study of women aged 55 or older who underwent endometrial sampling in our academic medical center between 1997 and 2008. Women who had a current or recent (< 2 years) histological diagnosis of NEH were included in the study group and were compared with those diagnosed with atrophic endometrium (AE). Outcome data were obtained until February 2018. The main outcomes were risk of progression to endometrial carcinoma and risk of persistence, recurrence or new development of endometrial hyperplasia (EH) ('persistent EH'). Logistic regression analysis was used to identify covariates that were independent risk factors for progression to endometrial cancer or persistent EH.
During the study period, 1808 women aged 55 or older underwent endometrial sampling. The median surveillance time was 10.0 years. Seventy-two women were found to have a current or recent diagnosis of NEH and were compared with 722 women with AE. When compared to women with AE, women with NEH had significantly higher body mass index (33.9 kg/m vs 30.6 kg/m ; P = 0.01), greater endometrial thickness (10.00 mm vs 6.00 mm; P = 0.01) and higher rates of progression to type-1 endometrial cancer (8.3% vs 0.8%; P = 0.0003) and persistent NEH (22.2% vs 0.7%; P < 0.0001). They also had a higher rate of progression to any type of uterine cancer or persistent EH (33.3% vs 3.5%; P < 0.0001). Women with NEH had a significantly higher rate of future surgical intervention (51.4% vs 15.8%; P < 0.0001), including future hysterectomy (34.7% vs 9.8%; P < 0.0001). On multivariable logistic regression analysis, only NEH remained a significant risk factor for progression to endometrial cancer or persistence of EH.
Postmenopausal women with NEH are at significant risk for persistent EH and progression to endometrial cancer, at rates higher than those reported previously. Guidelines for the appropriate management of postmenopausal women with NEH are needed in order to decrease the rate of persistent disease or progression to cancer. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
评估绝经后被诊断为非典型子宫内膜增生（NEH）的女性的长期预后。
这是一项回顾性研究，纳入了 1997 年至 2008 年期间在我院行子宫内膜取样的年龄 55 岁及以上的女性。研究组纳入了当前或近期（<2 年）有非典型子宫内膜增生组织学诊断的女性，并与诊断为萎缩性子宫内膜（AE）的女性进行比较。研究获取了截至 2018 年 2 月的结局数据。主要结局为进展为子宫内膜癌的风险和持续性、复发或新发子宫内膜增生（EH）的风险（“持续性 EH”）。采用 logistic 回归分析确定进展为子宫内膜癌或持续性 EH 的独立危险因素。
在研究期间，1808 名年龄 55 岁及以上的女性接受了子宫内膜取样。中位随访时间为 10.0 年。72 名女性当前或近期诊断为 NEH，与 722 名 AE 女性进行比较。与 AE 女性相比，NEH 女性的体重指数（33.9kg/m 与 30.6kg/m ；P=0.01）、子宫内膜厚度（10.00mm 与 6.00mm ；P=0.01）更高，且进展为 1 型子宫内膜癌（8.3% 与 0.8% ；P=0.0003）和持续性 NEH（22.2% 与 0.7% ；P<0.0001）的风险更高。她们进展为任何类型的子宫癌或持续性 EH 的风险也更高（33.3% 与 3.5% ；P<0.0001）。NEH 女性再次手术干预的风险更高（51.4% 与 15.8% ；P<0.0001），包括再次子宫切除术（34.7% 与 9.8% ；P<0.0001）。多变量 logistic 回归分析显示，只有 NEH 仍然是进展为子宫内膜癌或持续性 EH 的显著危险因素。
患有非典型子宫内膜增生的绝经后女性持续性 EH 和进展为子宫内膜癌的风险显著增加，其风险高于之前的报道。需要制定合适的管理绝经后非典型子宫内膜增生女性的指南，以降低持续性疾病或进展为癌症的风险。
