From the Department of Obstetrics, Gynecology and Reproductive Science.
Icahn School of Medicine at Mount Sinai, New York, NY.
Female Pelvic Med Reconstr Surg. 2021 Jun 1;27(6):e549-e554. doi: 10.1097/SPV.0000000000000990.
This study aimed to determine the prevalence of unanticipated uterine cancer and cervical cancer in women undergoing hysterectomy for uterovaginal prolapse.
Using data from the 2015-2018 American College of Surgeons National Surgical Quality Improvement Program, we identified adult women who underwent a hysterectomy with a concurrent procedure for uterovaginal prolapse. Patients who underwent a radical hysterectomy or had other procedures or diagnoses suggestive of preoperatively suspected or known gynecologic cancer were excluded. Our outcome measures were pathology-confirmed diagnoses of uterine cancer and cervical cancer. Bivariate statistical tests and multivariable logistic regression were used to identify patient characteristics associated with the likelihood of having unanticipated uterine cancer.
Among 9,687 patients meeting the sample eligibility criteria (median age, 60 years), 51 (0.53%; 95% confidence interval, 0.39%-0.69%) had a diagnosis of uterine cancer. Forty-three (84.3%) were stage I-IB. Multivariable logistic regression showed that older age (adjusted odds ratio, 2.75; 95% confidence interval, 1.47-5.51, for age >60 vs 41-60 years) and uterine weight greater than 250 g (adjusted odds ratio, 4.34; 95% confidence interval, 1.48-10.79) were associated with a significantly higher likelihood of having unexpected uterine malignancy. In addition, in a subsample of 7,908 patients who underwent a total hysterectomy, 7 (0.09%; 95% confidence interval, 0.04%-0.18%) had a diagnosis of cervical cancer.
The risk of unexpected uterine cancer and cervical cancer in women undergoing hysterectomy for uterovaginal prolapse was relatively low but should be appropriately considered when counseling patients desiring uterine- or cervix-sparing procedures.
本研究旨在确定因阴道子宫膨出而行子宫切除术的女性中，未预料到的子宫癌和宫颈癌的患病率。
我们利用 2015 年至 2018 年美国外科医师学会国家手术质量改进计划的数据，确定了因阴道子宫膨出而行子宫切除术且同时进行其他手术的成年女性。排除行根治性子宫切除术或其他提示术前疑似或已知妇科癌症的手术或诊断的患者。我们的结局指标为经病理证实的子宫癌和宫颈癌诊断。采用双变量统计检验和多变量逻辑回归来确定与未预料到的子宫癌发生可能性相关的患者特征。
在符合样本入选标准的 9687 例患者中（中位年龄 60 岁），51 例（0.53%；95%置信区间，0.39%-0.69%）诊断为子宫癌。43 例（84.3%）为Ⅰ期-ⅠB 期。多变量逻辑回归显示，年龄较大（调整后比值比，2.75；95%置信区间，1.47-5.51，年龄>60 岁与 41-60 岁相比）和子宫重量大于 250 g（调整后比值比，4.34；95%置信区间，1.48-10.79）与未预料到的子宫恶性肿瘤发生的可能性显著增加相关。此外，在 7908 例接受全子宫切除术的患者亚组中，7 例（0.09%；95%置信区间，0.04%-0.18%）诊断为宫颈癌。
因阴道子宫膨出而行子宫切除术的女性发生未预料到的子宫癌和宫颈癌的风险相对较低，但在为希望保留子宫或宫颈的患者提供咨询时，应适当考虑这一风险。
