Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienza Ospedaliero Universitaria di Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences, DIMEC, University of Bologna, Bologna, Italy.
Int J Gynaecol Obstet. 2024 Oct;167(1):214-222. doi: 10.1002/ijgo.15572. Epub 2024 May 13.
To evaluate the rate of disease progression and the factors associated with such progression in patients with an ultrasound diagnosis of adenomyosis.
This was a single center, prospective, observational, cohort study performed at a tertiary referral center. Patients who obtained an ultrasound diagnosis of adenomyosis from May 2022 to August 2022 were recruited. Demographic, clinical and ultrasound data were recorded at the first visit (T0) and after 12 months (T1) for enrolled patients and compared between T0 and T1. The study population was divided in two groups according to progression (increase in uterine volume >20%) or stability/regression (decrease or increase in uterine volume ≤20%) of adenomyosis at T1. Primary study outcome was the rate of adenomyosis progression, while secondary study outcome was the association of adenomyosis progression with demographic and clinical factors. Post hoc subgroups analyses for primary and secondary study outcomes were performed based on hormonal therapy (untreated and treated).
A total of 221 patients were enrolled in the study, with no significant difference in terms of baseline data among the two study groups and no patients were lost to follow-up. The overall rate of adenomyosis progression was 21.3% (47/221 patients). The rate was 30.77% in hormonally untreated women, and 18.34% in hormonally treated women. Progression was associated with the presence of focal adenomyosis of the outer myometrium (P = 0.037), moderate to severe dysmenorrhea (P = 0.001), chronic pelvic pain (P = 0.05), dyschezia (P = 0.05), and worsening of chronic pelvic pain (P = 0.04) at T1.
Adenomyosis showed a rate of disease progression of 21.3% at the 12-month follow-up (30.77% in hormonally untreated women, and 18.34% in hormonally treated women). The presence and/or worsening of painful symptoms, such as severe dysmenorrhea, dyschezia and chronic pelvic pain, as well as the presence focal adenomyosis of the outer myometrium, might help identify patients at higher risk of disease progression and tailor their follow-up.
评估经超声诊断为子宫腺肌病患者的疾病进展率及其相关因素。
这是一项在一家三级转诊中心进行的单中心、前瞻性、观察性队列研究。招募了 2022 年 5 月至 2022 年 8 月期间获得超声诊断为子宫腺肌病的患者。在第一次就诊（T0）和 12 个月后（T1）记录患者的人口统计学、临床和超声数据，并比较 T0 和 T1 之间的数据。根据 T1 时子宫腺肌病的进展（子宫体积增加>20%）或稳定/消退（子宫体积减少或增加≤20%），将研究人群分为两组。主要研究结局为子宫腺肌病的进展率，次要研究结局为子宫腺肌病的进展与人口统计学和临床因素的相关性。根据激素治疗（未治疗和治疗）对主要和次要研究结局进行了事后亚组分析。
共有 221 名患者入组研究，两组患者的基线数据无显著差异，无患者失访。子宫腺肌病进展的总体发生率为 21.3%（221 例患者中有 47 例）。未接受激素治疗的女性发生率为 30.77%，接受激素治疗的女性发生率为 18.34%。进展与外肌层局灶性子宫腺肌病（P=0.037）、中重度痛经（P=0.001）、慢性盆腔痛（P=0.05）、排便困难（P=0.05）以及慢性盆腔痛恶化（P=0.04）相关。
在 12 个月的随访中，子宫腺肌病的疾病进展率为 21.3%（未接受激素治疗的女性为 30.77%，接受激素治疗的女性为 18.34%）。严重痛经、排便困难和慢性盆腔痛等疼痛症状的存在和/或恶化，以及外肌层局灶性子宫腺肌病的存在，可能有助于识别疾病进展风险较高的患者，并为其制定随访计划。
