Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
Am J Obstet Gynecol. 2020 Dec;223(6):896.e1-896.e7. doi: 10.1016/j.ajog.2020.06.045. Epub 2020 Jul 5.
Proliferative endometrium has been reported in 15% of endometrial biopsies of women aged 50 years and older. Contrary to endometrial hyperplasia, proliferative endometrium has not been associated with the risk of endometrial cancer.
This study aimed to report on the long-term outcome of postmenopausal women who received a diagnosis of proliferative endometrium.
This is a retrospective cohort study of 1808 women aged 55 years and older who underwent endometrial sampling between January 1997 and December 2008. Outcome data were available through February 2018. Women with a proliferative endometrium were compared with those with an atrophic endometrium for future development of endometrial hyperplasia or cancer. A subanalysis was performed for those who presented with postmenopausal bleeding. Uni- and multivariable logistic regression analyses were used to assess for confounders.
In this study, 297 women (16.4%) received a diagnosis of proliferative endometrium. Furthermore, 962 women met the inclusion criteria. Among those women, 278 had a proliferative endometrium, and 684 had an atrophic endometrium. Women with a proliferative endometrium were younger (61.2 vs 64.5 years; P<.0001) and had a higher body mass index (33.9 vs 30.6 kg/m; P<.0001). More African American women had a proliferative endometrium. Both groups had a similar length of surveillance (11.9 vs 11.5 years; P=.27). Women with a proliferative endometrium had a higher risk of developing endometrial hyperplasia or cancer (11.9% vs 2.9%; P<.0001), any endometrial cancer (5.8% vs 1.8%; P=.002), atypical endometrial hyperplasia (2.2% vs 0.4%; P=.02), and nonatypical endometrial hyperplasia (2.0% vs 0.7%; P=.001). The risk of developing endometrial cancer and endometrial hyperplasia remained similar after excluding cases on hormonal replacement therapy (12.2% vs 3%; P=.001). On logistic regression analysis, proliferative endometrium histology (odds ratio, 3.89; 95% confidence interval, 2.03-7.49; P<.0001), age >60 years (odds ratio, 1.98; 95% confidence interval, 1.03-3.82; P=.04), and body mass index >35 kg/m (odds ratio, 2.3; 95% confidence interval, 1.09-4.83; P<.0001) remained significant risk factors for progression to cancer.
One of the 6 postmenopausal women who underwent endometrial sampling had a proliferative endometrium. Furthermore, 11.9% of women developed endometrial hyperplasia or cancer, a 4-fold greater incidence than women with an atrophic endometrium. The findings of this study suggest that long-term monitoring is warranted for women with postmenopausal bleeding and a proliferative endometrium histology. Further studies are needed to examine if a treatment is required to negate the risk of unopposed estrogen.
在 50 岁及以上的女性中，有 15%的子宫内膜活检报告为增生性子宫内膜。与子宫内膜增生不同，增生性子宫内膜与子宫内膜癌的风险无关。
本研究旨在报告绝经后接受增生性子宫内膜诊断的女性的长期结局。
这是一项回顾性队列研究，纳入了 1997 年 1 月至 2008 年 12 月期间接受子宫内膜取样的 1808 名 55 岁及以上的女性。研究结果可追溯至 2018 年 2 月。将增生性子宫内膜患者与萎缩性子宫内膜患者进行比较，以了解未来是否会发展为子宫内膜增生或癌症。对出现绝经后出血的患者进行了亚组分析。采用单变量和多变量逻辑回归分析来评估混杂因素。
本研究中，297 名（16.4%）女性被诊断为增生性子宫内膜。此外，有 962 名女性符合纳入标准。在这些女性中，278 名患有增生性子宫内膜，684 名患有萎缩性子宫内膜。患有增生性子宫内膜的女性年龄更小（61.2 岁 vs 64.5 岁；P<.0001），体重指数更高（33.9 千克/平方米 vs 30.6 千克/平方米；P<.0001）。更多的非裔美国女性患有增生性子宫内膜。两组的监测时间相似（11.9 年 vs 11.5 年；P=.27）。患有增生性子宫内膜的女性发生子宫内膜增生或癌症的风险更高（11.9% vs 2.9%；P<.0001）、任何类型的子宫内膜癌（5.8% vs 1.8%；P=.002）、非典型子宫内膜增生（2.2% vs 0.4%；P=.02）和非典型子宫内膜增生（2.0% vs 0.7%；P=.001）的风险更高。在排除激素替代疗法的病例后，发生子宫内膜癌和子宫内膜增生的风险仍然相似（12.2% vs 3%；P=.001）。逻辑回归分析显示，增生性子宫内膜组织学（比值比，3.89；95%置信区间，2.03-7.49；P<.0001）、年龄>60 岁（比值比，1.98；95%置信区间，1.03-3.82；P=.04）和体重指数>35 千克/平方米（比值比，2.3；95%置信区间，1.09-4.83；P<.0001）仍然是进展为癌症的显著危险因素。
在接受子宫内膜取样的 6 名绝经后女性中，有 1 名患有增生性子宫内膜。此外，有 11.9%的女性发生子宫内膜增生或癌症，发病率是萎缩性子宫内膜患者的 4 倍。本研究结果表明，对于出现绝经后出血和增生性子宫内膜组织学的女性，需要进行长期监测。需要进一步研究是否需要治疗来消除雌激素的不良影响。
