子宫内膜不典型增生患者术后病理升级的特征分析

Analysis of features of atypical hyperplasia patients with postoperative pathologic upgrade

目的探讨诊断性刮宫病理结果为子宫内膜不典型增生(atypical hyperplasia,AH)患者子宫切除术后病理升级为子宫内膜癌(endometrial cancer,ECa)的高危因素和临床病理特征。方法分析2002年1月至2018年12月间,因诊断性刮宫病理提示AH而行全子宫切除术的166例患者的临床病理资料,根据全子宫切除术后的病理结果分为ECa组(74例)和AH组(92例),分析两组的临床特征,术后病理升级的高危因素。以同期诊断性刮宫病理为ECa而行全子宫切除术的患者(325例)为对照组,分析术后病理升级ECa患者的病理特征。结果166例纳入患者中子宫切除术后病理升级发生率44.58%(74/166)。单因素分析结果显示高龄、绝经、异常出血时间长、子宫内膜厚、未采用宫腔镜是术后病理升级的高危因素(P<0.05)。多因素分析显示高龄、子宫内膜厚是术后病理升级的高危因素,其中绝经后患者的高危因素包括高龄、延迟绝经和异常出血时间长(P<0.05)。术后病理升级的ECa均为子宫内膜样腺癌,91.89%(68/74)手术分期为Ia期,74.32%(55/74)病理分级为高分化。结论诊断性刮宫病理结果为AH的患者44.58%合并遗漏的ECa,子宫切除术后出现病理升级。高危因素包括:高龄、延迟绝经、绝经后、异常子宫出血病程长、绝经前子宫内膜增厚明显、绝经后未使用宫腔镜直接进行诊断性刮宫。术后病理升级发现的ECa患者通常为子宫内膜样腺癌,组织分化程度高、期别早,预后好。

Objective To investigate high-risk factors and clinicopathological features associated with atypical hyperplasia(AH)patients with postoperative pathologic upgrade to endometrial cancer(ECa).Methods Clinicopathological data was obtained from 166 patients who underwent total hysterectomy for the treatment of AH(diagnosed by curettage)from January 2002 to December 2018 and were retrospectively analyzed.On the basis of the pathological evaluations post total hysterectomy,the patients were classified into two groups:ECa(74 cases)and AH(92 cases).The clinical features of the two groups were further analyzed to identify the high-risk factors responsible for the postoperative pathological upgrade to ECa.The pathologic features of patients was analyzed,who were diagnosed with AH by curettage but with postoperative pathologic upgrade to ECa after hysterectomy.Totally 325 patients diagnosed with ECa by curettage during the same period were set as the control.Results ECa was found in 74 of the 166 patients who underwent hysterectomy due to AH,with an incidence rate of 44.58%(74/166).Univariate analysis showed that advanced age,menopause,long-term abnormal bleeding,and endometrial thickening without hysteroscopy were high-risk factors associated with the postoperative pathological upgrade to ECa(P<0.05).Furthermore,advanced age,late menopause,endometrial thickening and long-term abnormal bleeding contributed mainly to the postoperative pathological upgrade to ECa,as suggested by multivariate analysis(P<0.05).All patients with postoperative pathological upgrade to ECa were endometrial adenocarcinoma,of which 91.89%(68/74)of the surgical pathological stages were stage Ia,and 74.32%(55/74)of the pathological grades were well differentiated.Conclusion ECa was found in 44.58%of patients with AH diagnosed by curettage,which led to pathological upgrade after hysterectomy.Advanced age,menopause,late menopause,long-term abnormal bleeding,premenopausal endometrial thickening,and postmenopausal curettage without hysteroscopy contributed to pathological upgrade to ECa.ECa found by postoperative pathological upgrade are usually endometrioid adenocarcinoma with high degree of tissue differentiation,early stage and good prognosis.