Department of Women's and Children's Health, Division of Neonatology, Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
Acta Obstet Gynecol Scand. 2022 Aug;101(8):923-930. doi: 10.1111/aogs.14385. Epub 2022 May 27.
Minimally invasive methods to reduce menorrhagia were introduced in the 1980s and 1990s. Transcervical endometrial resection (TCRE) and endometrial ablation (EA) are two of the most frequently used methods. As none of them can guarantee a complete removal of the endometrium, there are concerns that the remaining endometrium may develop to endometrial cancer (EC) later in life. The primary aim was to analyze the long-term incidence of EC after TCRE and EA in a nationwide population. The secondary aim was to assess the two treatment modalities separately.
The Swedish National Patient Registry and National Quality Registry for Gynecological Surgery were used for identification of women who had TCRE or EA performed between 1997-2017. The cohort was followed from the first TCRE or EA until hysterectomy, diagnosis of EC, or death. Follow-up data were retrieved from the National Cancer Registry and the National Death Registry. Expected incidence for EC in Swedish women was calculated using Swedish data retrieved from the NORDCAN project after having taken into account differences of age and follow-up time. Cumulative incidence of EC after TCRE and EA, was calculated. A standardized incidence ratio was calculated based on the expected and observed incidence, stratified by age and year of diagnosis.
In total, 17 296 women (mean age 45.1 years) underwent TCRE (n = 8626) or EA (n = 8670). Excluded were 3121 who had a hysterectomy for benign causes during follow up. During a median follow-up time of 7.1 years (interquartile range 3.1-13.3 years) the numbers of EC were 25 (0.3%) after TCRE and 2 (0.02%) after EA, respectively. The observed incidence was significantly lower than expected (population-based estimate) after EA but not after TCRE, giving a standardized incidence ratio of 0.13 (95% confidence interval [CI] 0.03-0.53) after EA and 1.27 (95% CI 0.86-1.88) after TCRE. Median times to EC were 3.0 and 8.3 years after TCRE and EA, respectively.
There was a significant reduction of EC after EA, suggesting a protective effect, whereas endometrial resection showed an incidence within the expected rate.
20 世纪 80 年代和 90 年代引入了减少月经过多的微创方法。经宫颈子宫内膜切除术（TCRE）和子宫内膜消融术（EA）是最常用的两种方法。由于它们都不能保证子宫内膜完全切除，因此人们担心剩余的子宫内膜以后可能会发展为子宫内膜癌（EC）。主要目的是分析全国范围内 TCRE 和 EA 后子宫内膜癌的长期发病率。次要目的是分别评估这两种治疗方法。
使用瑞典国家患者登记处和国家妇科手术质量登记处来确定 1997 年至 2017 年间进行 TCRE 或 EA 的女性。该队列从第一次 TCRE 或 EA 开始，直到子宫切除术、EC 诊断或死亡。随访数据从国家癌症登记处和国家死亡登记处获取。使用 NORDCAN 项目从瑞典获得的年龄和随访时间差异考虑在内的女性 EC 的预期发病率。计算 TCRE 和 EA 后 EC 的累积发病率。根据预期和观察到的发病率，按年龄和诊断年份计算标准化发病率比。
共有 17296 名女性（平均年龄 45.1 岁）接受了 TCRE（n=8626）或 EA（n=8670）。在随访期间，有 3121 名女性因良性原因行子宫切除术。中位随访时间为 7.1 年（四分位距 3.1-13.3 年），TCRE 后 EC 数量为 25 例（0.3%），EA 后为 2 例（0.02%）。观察到的发病率明显低于 EA 后的预期（基于人群的估计），但 TCRE 后并非如此，EA 后的标准化发病率比为 0.13（95%置信区间 [CI] 0.03-0.53），而 TCRE 后的标准化发病率比为 1.27（95% CI 0.86-1.88）。TCRE 和 EA 后 EC 的中位时间分别为 3.0 年和 8.3 年。
EA 后 EC 发生率显著降低，提示有保护作用，而子宫内膜切除术的发生率在预期范围内。
