Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Ponekkara Rd, Edappally, Kochi, Ernakulam, Kerala 682041, India.
Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Ponekkara Rd, Edappally, Kochi, Ernakulam, Kerala 682041, India.
Eur J Obstet Gynecol Reprod Biol. 2024 Dec;303:1-8. doi: 10.1016/j.ejogrb.2024.09.044. Epub 2024 Oct 3.
The study aimed to evaluate the incidence of concurrent endometrial cancer (EC) and lymph node positivity in patients with Atypical Endometrial Hyperplasia (AEH) who underwent surgical staging with sentinel lymph node evaluation. It also sought to identify the risk factors associated with detecting concurrent endometrial cancer in patients with a preoperative diagnosis of AEH.
A retrospective study was conducted at Amrita Institute of Medical Sciences, involving 54 cases of AEH diagnosed on pre-operative biopsy specimens and undergoing staging surgery between January 1, 2015, and December 31, 2020. The study analysed demographic parameters, clinical presentations, pathological features, and clinical outcomes. Categorical variables were expressed in numbers and percentages, normal distribution data were presented as mean, and non-normal distribution data were presented as median and range.
Fifty-four patients diagnosed with AEH underwent surgical staging. The median age was 54 years. Final HistoPathology Report (HPR) showed 48.14 % with AEH and 51.85 % with concurrent EC. Among those with concurrent EC, 96.4 % had type I EC, and one patient was upgraded to type 2 EC. Among them, 17.8 % patients belonged to high-intermediate and high-risk categories. Patients with AEH and concurrent EC were more likely to be diabetic (OR: 3.56, p = 0.04), have a BMI ≥25 kg/m2 (OR: 1.47, p = 0.04), exhibit a thickened endometrial lining of ≥9 mm (OR: 3.13, p = 0.05) on ultrasound, and undergo preoperative biopsy at a non-oncology centre (OR: 8.33, p = 0.001) whereas experiencing heavy menstrual bleeding had a substantially lower likelihood (OR: 0.29, p = 0.01) of developing concurrent EC.
The study revealed that more than half of patients undergoing staging surgery for AEH were found to be at risk of having concurrent EC in their final HPR. The research also pointed out that surgical staging can help identify both low-risk and high-risk ECs, which may require additional treatment. Higher BMI, diabetes mellitus, and an endometrial thickness of ≥9 mm were identified as significant risk factors for concurrent EC. Additionally, heavy menstrual bleeding was associated with a decreased risk of concurrent EC.
本研究旨在评估接受前哨淋巴结评估的手术分期的非典型子宫内膜增生（AEH）患者中同时发生子宫内膜癌（EC）和淋巴结阳性的发生率，并确定术前诊断为 AEH 的患者中同时发生子宫内膜癌的相关风险因素。
本研究为回顾性研究，在 2015 年 1 月 1 日至 2020 年 12 月 31 日期间，在阿姆里塔医学科学研究所对 54 例经术前活检诊断为 AEH 的患者进行了研究，对其进行了手术分期。本研究分析了人口统计学参数、临床表现、病理特征和临床结局。分类变量用数字和百分比表示，正态分布数据用平均值表示，非正态分布数据用中位数和范围表示。
54 例诊断为 AEH 的患者接受了手术分期。中位年龄为 54 岁。最终组织病理学报告（HPR）显示 48.14%为 AEH，51.85%为同时发生的 EC。在同时发生 EC 的患者中，96.4%为 I 型 EC，1 例患者升级为 II 型 EC。其中，17.8%的患者属于中高危类别。AEH 伴 EC 的患者更可能患有糖尿病（OR：3.56，p=0.04）、BMI≥25kg/m2（OR：1.47，p=0.04）、超声下子宫内膜增厚≥9mm（OR：3.13，p=0.05），且术前活检在肿瘤中心以外的机构进行（OR：8.33，p=0.001），而经历月经过多的患者发生同时性 EC 的可能性显著降低（OR：0.29，p=0.01）。
本研究表明，接受 AEH 分期手术的患者中，超过一半的患者在最终 HPR 中存在同时发生 EC 的风险。研究还指出，手术分期可以帮助识别低风险和高风险的 EC，这可能需要额外的治疗。较高的 BMI、糖尿病和子宫内膜厚度≥9mm 被确定为同时发生 EC 的显著危险因素。此外，月经过多与同时发生 EC 的风险降低有关。
