Section of General Internal Medicine (Drs. Rodríguez Bronico and Paasche-Orlow); Department of Obstetrics and Gynecology (Drs. Matthews, Perkins, and Lee); Boston University School of Medicine, Department of Health Law, Policy, and Management, Boston University School of Public Health (Dr. Morgan), Boston; Gynecologic Oncology, Beth Israel Lahey Health, Burlington (Dr. Nitschmann), Massachusetts.
Section of General Internal Medicine (Drs. Rodríguez Bronico and Paasche-Orlow); Department of Obstetrics and Gynecology (Drs. Matthews, Perkins, and Lee); Boston University School of Medicine, Department of Health Law, Policy, and Management, Boston University School of Public Health (Dr. Morgan), Boston; Gynecologic Oncology, Beth Israel Lahey Health, Burlington (Dr. Nitschmann), Massachusetts.
J Minim Invasive Gynecol. 2021 Jun;28(6):1231-1236. doi: 10.1016/j.jmig.2020.10.015. Epub 2020 Oct 25.
To characterize the short-term incidence of gynecologic cancer after undergoing uterine artery embolization (UAE).
Retrospective cohort study.
Commercial insurance claims database.
Total of 15 393 United States women aged 18 to 64 years who underwent UAE between 2007 and 2017.
We used the IBM MarketScan (Armonk, NY) claims to identify adult women without previous gynecologic cancer diagnoses undergoing UAE between 2007 and 2017. Database queries identified women with any diagnostic or procedure codes related to gynecologic malignancies occurring in the first 3 years after UAE. A malignancy diagnosis was suggested by recurrent malignancy-related claims not linked exclusively to diagnostic testing (e.g., transvaginal ultrasound) and malignancy codes linked to tissue pathology claims. Incidence of malignancy diagnosis was calculated. Rates of endometrial sampling in the year before UAE were identified.
Thirty-one women undergoing UAE had gynecologic cancer diagnoses within 3 years of the procedure (22 of 31, 71% uterine cancers; 7 of 31, 23% ovarian cancers; and 2 of 31, 6% cervical cancers). On average, cancer diagnoses were made 1.1 ± 0.9 years after UAE. One in 497 women undergoing UAE was diagnosed with a gynecologic malignancy within 3 years, with an incidence of 1.1 malignancies per 1000 person-years. Cancer incidence increased with age at the time of UAE: short-term malignancy diagnoses were made in 1 in 377 women aged 45 to 54 years, and 1 in 79 women aged 55 to 64 years. In the year before UAE, 28% (4311 of 15 362) of women without cancer, and 23% (5 of 22) of women diagnosed with uterine cancer had preprocedural endometrial sampling.
These data can inform risk/benefit counseling and shared decision-making regarding UAE and its alternatives. Short-term malignancies after UAE highlight the importance of preprocedure evaluation in symptomatic women and women with age-related risk.
描述行子宫动脉栓塞术（UAE）后妇科癌症的短期发病率。
回顾性队列研究。
商业保险索赔数据库。
2007 年至 2017 年间在美国接受 UAE 的 15393 名 18 至 64 岁的成年女性。
我们使用 IBM MarketScan（纽约州阿蒙克）索赔来识别 2007 年至 2017 年间没有先前妇科癌症诊断的成年女性，接受 UAE。数据库查询确定了在 UAE 后 3 年内出现任何与妇科恶性肿瘤相关的诊断或手术代码的女性。通过与组织病理学索赔相关的反复恶性肿瘤相关索赔而不是专门与诊断性检查（例如阴道超声）相关的恶性肿瘤代码来提示恶性肿瘤诊断。计算恶性肿瘤诊断的发生率。确定 UAE 前 1 年进行子宫内膜取样的比例。
31 名接受 UAE 的女性在手术 3 年内被诊断患有妇科癌症（31 例中有 22 例为子宫癌；31 例中有 7 例为卵巢癌；31 例中有 2 例为宫颈癌）。平均而言，癌症诊断在 UAE 后 1.1±0.9 年内做出。每 497 名接受 UAE 的女性中就有 1 名在 3 年内被诊断患有妇科恶性肿瘤，每 1000 人年发生 1.1 例恶性肿瘤。随着 UAE 时年龄的增加，癌症发病率增加：45 至 54 岁的女性中，每 377 例中有 1 例短期恶性肿瘤诊断，55 至 64 岁的女性中，每 79 例中有 1 例。在 UAE 前 1 年，没有癌症的女性中有 28%（15362 名中的 4311 名），而被诊断为子宫癌的女性中有 23%（22 名中的 5 名）进行了术前子宫内膜取样。
这些数据可以为 UAE 及其替代方法的风险/获益咨询和共同决策提供信息。UAE 后短期发生的恶性肿瘤强调了在有症状的女性和年龄相关风险的女性中进行术前评估的重要性。
