Department of Obstetrics and Gynaecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea.
J Obstet Gynaecol. 2022 Oct;42(7):3067-3072. doi: 10.1080/01443615.2022.2091925. Epub 2022 Jul 1.
Leiomyosarcomas may originate from pre-existing uterine fibroids. However, recent studies showed that leiomyosarcomas do not arise from malignant changes in fibroids. Epidemiological data on the long-term risk of uterine malignancy with uterine fibroids are lacking. We aimed to determine whether uterine fibroids are a risk factor for uterine cancer. Patient data (2007-2020) from the Korean Health Insurance program were obtained. Using the procedure and diagnostic codes, data from patients who underwent myomectomy and appendicitis (control group) were extracted Using 1:1 propensity-score matching, 84,507 women were each allocated to the uterine fibroids and control groups. Endometrial cancer occurred in 36 44 and 44 36 women in the uterine fibroids and control groups ( = .371), respectively; 6/36 46 and 4 5/44 37 cases of uterine corpus cancer sarcoma occurred in the respective groups. Total uterine cancer (excluding cervical cancer) occurred in 46 and 39 37patients in the uterine fibroids and control groups, respectively ( = .323). A higher risk of uterine malignancy was not found in women with uterine fibroids confirmed by myomectomy. If surgery is indicated, a myomectomy can be safely performed without increasing the cancer risk. IMPACT STATEMENT Traditionally, leiomyosarcomas were considered to originate from pre-existing uterine fibroids. However, recent studies suggest that leiomyosarcomas do not arise from the malignant change of fibroids. Meanwhile, there is a dearth of real-world evidence on the risk of uterine cancer in patients with uterine fibroids. No evidence of a higher risk of uterine malignancy was found in women having uterine fibroids confirmed by myomectomy in this population-based study. In our cohort of women with uterine fibroids, tissue injury by myomectomy does not appear to cause malignant transformation. Uterine fibroids doesn't appear to be a risk factor for uterine malignancies, and tissue injury by myomectomy does not appear to cause malignant transformation. If surgery is indicated, myomectomy can be performed safely, given that the long-term risk of uterine malignancy does not increase.
平滑肌肉瘤可能起源于先前存在的子宫肌瘤。然而，最近的研究表明，平滑肌肉瘤并非来源于肌瘤的恶性变化。关于子宫肌瘤患者发生子宫恶性肿瘤的长期风险的流行病学数据尚缺乏。我们旨在确定子宫肌瘤是否是子宫癌的一个危险因素。我们从韩国健康保险计划中获得了 2007 年至 2020 年期间的患者数据。使用手术和诊断代码，提取了接受子宫肌瘤切除术和阑尾炎（对照组）的患者的数据。通过 1:1 倾向评分匹配，将 84507 名女性分别分配到子宫肌瘤组和对照组。在子宫肌瘤组和对照组中，分别有 36 例和 44 例患者发生子宫内膜癌（=0.371）；分别有 6/3646 例和 4/5/4437 例子宫体癌肉瘤发生在各自的组中。在子宫肌瘤组和对照组中，分别有 46 例和 3937 例患者发生总子宫癌（不包括宫颈癌）（=0.323）。通过子宫肌瘤切除术证实患有子宫肌瘤的女性，并未发现其患子宫恶性肿瘤的风险更高。如果需要手术，安全地进行子宫肌瘤切除术而不会增加癌症风险。
传统上，平滑肌肉瘤被认为起源于先前存在的子宫肌瘤。然而，最近的研究表明，平滑肌肉瘤并非来源于肌瘤的恶性变化。同时，关于患有子宫肌瘤的患者发生子宫癌的风险，尚无真实世界的证据。在这项基于人群的研究中，通过子宫肌瘤切除术证实患有子宫肌瘤的女性，并未发现其患子宫恶性肿瘤的风险更高。在我们的子宫肌瘤患者队列中，子宫肌瘤切除术引起的组织损伤似乎不会导致恶性转化。子宫肌瘤似乎不是子宫恶性肿瘤的危险因素，而子宫肌瘤切除术引起的组织损伤似乎不会导致恶性转化。如果需要手术，鉴于子宫恶性肿瘤的长期风险不会增加，子宫肌瘤切除术可以安全进行。
