Bigby Susan M, Tin Tin Sandar, Eva Lois J, Shirley Phillipa, Dempster-Rivett Kieran, Elwood Mark
Laboratory Services, Middlemore Hospital, Counties Manukau, Auckland, New Zealand.
Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
Aust N Z J Obstet Gynaecol. 2020 Apr;60(2):250-257. doi: 10.1111/ajo.13108. Epub 2020 Jan 5.
Endometrial carcinoma (EC) is increasing in incidence, attributed largely to the obesity epidemic. Ethnic differences in New Zealand have long been recognised, with Pacific women bearing the greater burden of disease. We hypothesise that the pooled national incidence rates underestimate the true burden of EC in our high-risk community.
We aimed to: (1) determine the incidence, trends and outcome of EC in the high-risk community served by our hospital, relative to national data; and (2) examine associated demographic, and clinicopathological features with reference to risk factors, to identify potential clinical and population intervention points.
All area-resident women treated for EC at Middlemore Hospital from 2000 to 2014 were identified from records, and clinicopathological data obtained. Incidence and time trend analyses were performed with reference to tumour type, age and ethnicity.
The study included 588 women. Pacific, followed by Māori, women had the highest incidence of EC (relative risk = 5.11 and 2.47, respectively, relative to 'Other' women). The incidence increased for all ethnicities (annual percentage change (APC) of 7.3; 95% CI 3.6-11.1), most marked in women aged below 50 years (APC of 12.2; 95% CI 5.2-19.7). This occurred predominantly in Pacific women, who had a high prevalence of potentially reversible risk factors. Disease-specific survival was worse in Pacific, and to a lesser extent, Māori women.
Prompt investigation of symptomatic, high-risk women regardless of age may detect endometrial abnormalities at an early, potentially reversible stage. The prevention and management of identifiable high-risk factors would help mitigate the risk of EC and associated diseases.
子宫内膜癌（EC）的发病率正在上升，这在很大程度上归因于肥胖症的流行。新西兰的种族差异早已为人所知，太平洋岛裔女性承受着更大的疾病负担。我们推测，全国汇总发病率低估了我们高危社区中EC的实际负担。
我们旨在：（1）确定我院服务的高危社区中EC的发病率、趋势和结局，并与全国数据进行比较；（2）参照风险因素检查相关的人口统计学和临床病理特征，以确定潜在的临床和人群干预点。
从记录中识别出2000年至2014年在Middlemore医院接受EC治疗的所有本地女性，并获取临床病理数据。参照肿瘤类型、年龄和种族进行发病率和时间趋势分析。
该研究纳入了588名女性。太平洋岛裔女性，其次是毛利女性，EC发病率最高（相对于“其他”女性，相对风险分别为5.11和2.47）。所有种族的发病率均有所上升（年百分比变化（APC）为7.3；95%可信区间3.6-11.1），在50岁以下女性中最为明显（APC为12.2；95%可信区间5.2-19.7）。这主要发生在太平洋岛裔女性中，她们具有高患病率的潜在可逆风险因素。太平洋岛裔女性以及程度较轻的毛利女性的疾病特异性生存率较差。
对有症状的高危女性，无论年龄大小，进行及时检查可能会在早期、潜在可逆阶段发现子宫内膜异常。对可识别的高危因素进行预防和管理将有助于降低EC及相关疾病的风险。
