子宫内膜不典型增生术后病理升级为子宫内膜癌的危险因素分析

Analysis of High Risk Factors for Postoperative Pathological Escalation of En-dometrial Atypical Hyperplasia

目的:研究子宫内膜不典型增生(AEH)术后病理升级为子宫内膜癌(EC)的相关危险因素。方法:选择2017年7月至2019年9月就诊于安徽医科大学第一附属医院门诊,经过诊断性刮宫明确为AEH并行全子宫切除术的166例患者为研究对象,并根据术后病理检查结果分为EC组(94例)和非EC组(72例)。分析患者术前与术后病理诊断的符合率、漏诊率及单因素和多因素Logistic回归分析AEH术后病理升级为EC的高危因素。结果:诊断性刮宫对AEH诊断的符合率为36.14%(60/166),对EC诊断的漏诊率为56.63%(94/166)。单因素分析结果示,EC组患者的发病年龄均值及年龄≥49.5岁、术前CA 125均值及CA 125升高、合并糖尿病的比例均显著高于非EC组患者,差异有统计学意义(P<0.05)。多因素二分类Logistic回归分析示,发病年龄≥49.5岁(OR 4.548,95%CI 2.246~9.210,P=0.000)、CA 125升高(OR 7.635,95%CI 2.326~25.060,P=0.001)为AEH术后病理升级为EC的独立危险因素,而合并糖尿病(OR 2.969,95%CI 0.557~15.822,P=0.202)不是AEH升级为EC的独立危险因素。结论:临床上应对年龄大于49.5岁及CA 125升高的AEH高危人群加强筛查,以期对EC达到早期诊治的目的。

Objective:To explore the high-risk factors of pathological escalation from endometrial atypical hy-perplasia(AEH)to endometrial cancer(EC)after surgical treatment.Methods:166 patients who were diagnosed as AEH by curettage and received hysterectomy were enrolled during July 2017 to September 2019 at the outpa-tient department of the First Affiliated Hospital of Anhui Medical University.The patients were divided into EC group(n=94)and non-EC group(n=72)according to pathological results after surgery.The pathological diagnosis be-fore and after hysterectomy was analyzed and compared to evaluate the coincidence rate and missed diagnosis rate Single-and multi-factor logistic regression analysis were performed to evaluate the high risk factors of patho-logical escalation of AEH after surgery.Results:The coincidence rate of curettage diagnosis of AEH patients was 36.14%(60/166),and the missed diagnosis rate of EC was 56.63%(94/166).Univariate analysis showed that the mean age of onset and age≥49.5 years,the mean CA 125 before operation and the proportion of diabetes in EC group were significantly higher than those in non-EC Group(P<0.05).Multivariate logistic regression analysis showed that age≥49.5 years(OR 4.548,95%CI 2.246-9.210,P=0.000),CA 125 increase(OR 7.635,95%CI 2.326-25.060,P=0.001)were independent risk factors of pathological escalation from AEH to EC.However,dia-betes Mellitus(OR 2.969,95%CI 0.557-15.822,P=0.202)was not an independent risk factor forpathological escalation.Conclusions:For early diagnosis and treatment of EC,screening should be strengthened in high risk population of AEH with advanced age(>49.5)and increased CA 125.