Al-Rayes Sarah, Mohamed Mariam, Suarthana Eva, Kigloo Hormoz Nassiri, Raina Jason, Tulandi Togas
Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
Department of Obstetrics and Gynecology, McGill University, Montreal, Canada.
Gynecol Minim Invasive Ther. 2025 Feb 27;14(1):40-50. doi: 10.4103/gmit.GMIT-D-24-00056. eCollection 2025 Jan-Mar.
To evaluate factors associated with malignancy in patients with endometrial polyps.
We conducted electronic database research on PubMed, MEDLINE, EMBASE, COCHRANE, and Google Scholar from inception for all studies on endometrial polyp. After removing duplicates, and title and abstract screening, we had a total of 121 articles and 151 others from screening the reference list. Inclusion criteria included peri and postmenopausal women > 45 years diagnosed histopathologically with endometrial polyp(s). We excluded women with a history of endometrial cancer or hysterectomy.
Twenty studies were analyzed. Of 11204 patients with endometrial polyp, 287 had malignant polyps (2.75%), 182 (1.8%) had concomitant endometrial hyperplasia with atypia, and 520 (5.2%) had hyperplasia without atypia within the polyp. Menopausal women had a higher risk of pre-malignancy/malignancy than non-menopausal women (OR 5.63 (95CI 3.87, 8.20, = 0%, < 0.001). Endometrial thickness on ultrasound in pre-malignancy/malignancy cases was significantly thicker than in the benign polyp (mean difference 4.2 mm, 95% CI 0.8 to 7.6 mm, = 18%, = 0.02). Women who used tamoxifen or hormone replacement therapy (HRT) had a lower likelihood of endometrial pre-malignancy/malignancy, while women with abnormal uterine bleeding (AUB) had a higher probability of pre-malignancy/malignancy. The odd ratio of having pre-malignancy/malignancy among those who used tamoxifen was 0.50 (95% CI 0.26-0.94: 12%, = 0.03).
In women with endometrial polyp, menopausal age and thickened endometrium might increase the probability while tamoxifen or HRT use might lower the likelihood of endometrial pre-malignancy/malignancy; and the presence of AUB might signal endometrial pre-malignancy/malignancy.
评估子宫内膜息肉患者发生恶性病变的相关因素。
我们对PubMed、MEDLINE、EMBASE、COCHRANE和谷歌学术等电子数据库进行了检索，从建库起查找所有关于子宫内膜息肉的研究。去除重复文献，并经过标题和摘要筛选后，我们从参考文献列表筛选中又获得了121篇文章和151篇其他文献。纳入标准包括年龄大于45岁的围绝经期和绝经后女性，经组织病理学诊断为子宫内膜息肉。我们排除了有子宫内膜癌病史或接受过子宫切除术的女性。
分析了20项研究。在11204例子宫内膜息肉患者中，287例患有恶性息肉（2.75%），1例82（1.8%）伴有不典型子宫内膜增生，520例（5.2%）息肉内有不伴有不典型增生的增生。绝经后女性发生癌前病变/恶性病变的风险高于未绝经女性（比值比5.63（95%置信区间3.87, 8.20，P = 0%，P < 0.001）。癌前病变/恶性病变病例的超声子宫内膜厚度明显厚于良性息肉（平均差异4.2mm，95%置信区间0.8至7.6mm，P = 18%，P = 0.02）。使用他莫昔芬或激素替代疗法（HRT）的女性发生子宫内膜癌前病变/恶性病变的可能性较低，而有异常子宫出血（AUB）的女性发生癌前病变/恶性病变的概率较高。使用他莫昔芬的患者发生癌前病变/恶性病变的比值比为0.50（95%置信区间0.26-0.94：P = 12%，P = 0.03）。
对于患有子宫内膜息肉的女性，绝经年龄和子宫内膜增厚可能增加发生子宫内膜癌前病变/恶性病变的概率，而使用他莫昔芬或HRT可能降低其发生概率；AUB的存在可能提示子宫内膜癌前病变/恶性病变。
