Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.
Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
Aust N Z J Obstet Gynaecol. 2021 Apr;61(2):275-283. doi: 10.1111/ajo.13300. Epub 2021 Jan 6.
Our objective was to assess clinical and pathological factors associated with a final diagnosis of endometrial carcinoma in patients with atypical endometrial hyperplasia with a particular emphasis on the grading of atypia.
A retrospective review over five years on patients (N = 97) who underwent hysterectomy for a diagnosis of atypical endometrial hyperplasia at a statewide public tertiary gynaecologic oncology centre. Clinical and pathological characteristics were obtained.
The rate of concurrent endometrial carcinoma was 34% (n = 33) with most being stage 1A endometrioid. A significant group difference was reported for age at diagnosis (t = -2.20 P = 0.031 d = 0.43) with carcinoma patients on average older (M = 60.2 (8.9) years) than patients without carcinoma (M = 55.5 (12.3) years). No significant group differences were found for body mass index, endometrial thickness or time between diagnosis and treatment. Significantly higher rates of carcinoma were reported in patients with moderate atypical hyperplasia (27.6%) and severe atypical hyperplasia (66.7%), compared to mild atypical hyperplasia (7.1%). Only severe atypical hyperplasia (odds ratio (OR) = 21.5, 95% CI 2.8-163.1, P = 0.003) and postmenopausal status (OR = 13.2, 95% CI 1.3-139.0, P = 0.032) significantly increased the risk of carcinoma in a multivariate model.
Severe atypical hyperplasia and postmenopausal status were significant predictors of concurrent endometrial carcinoma in patients with atypical endometrial hyperplasia. The grading of atypical hyperplasia may be utilised by gynaecologic oncologists in the triage and referral process of managing these patients; however, the grading system requires external validation in larger prospective studies.
我们的目的是评估与子宫内膜增生伴非典型性患者最终诊断为子宫内膜癌相关的临床和病理因素，特别强调非典型性分级。
对一家州立公立妇科肿瘤学中心 5 年来因诊断为非典型性子宫内膜增生而行子宫切除术的患者（N=97）进行回顾性研究。获取临床和病理特征。
同时患有子宫内膜癌的比例为 34%（n=33），大多数为 1A 期子宫内膜样癌。报道了年龄（t=-2.20 P=0.031 d=0.43）的显著组间差异，癌患者的平均年龄（M=60.2（8.9）岁）大于无癌患者（M=55.5（12.3）岁）。体重指数、子宫内膜厚度或诊断与治疗之间的时间无显著组间差异。中度非典型增生（27.6%）和重度非典型增生（66.7%）患者的癌发生率明显高于轻度非典型增生（7.1%）。仅重度非典型增生（比值比（OR）=21.5，95%CI 2.8-163.1，P=0.003）和绝经后状态（OR=13.2，95%CI 1.3-139.0，P=0.032）在多变量模型中显著增加了癌的风险。
重度非典型增生和绝经后状态是非典型性子宫内膜增生患者并发子宫内膜癌的显著预测因素。非典型性增生的分级可能被妇科肿瘤医生用于管理这些患者的分诊和转诊过程；然而，该分级系统需要在更大的前瞻性研究中进行外部验证。
