绝经后女性子宫内膜息肉发生癌前病变及癌变的危险因素及预测

Risk Factors and Prediction of Precancerous Lesions and Canceration of Endometrial Polyps in Postmenopausal Women

目的:探讨绝经后女性子宫内膜息肉(EP)发生癌前病变及癌变的危险因素,并构建风险预测列线图模型。方法:回顾性分析2017年1月-2021年1月在三明市第一医院妇科就诊的106例绝经后彩超提示子宫内膜息肉患者的手术资料。按照病理结果将患者分为良性病变组(83例)与癌前病变/癌变组(23例)。对两组的一般资料、合并症、检查结果、彩超结果进行单因素分析,筛选高危因素,构建列线图预测模型,使用ROC曲线评估预测模型区分度。结果:单因素分析提示体重指数(BMI)、肥胖、是否合并异常子宫内膜出血、绝经后阴道是否出血/流液、乳腺增生、甘油三酯、空腹血糖、糖类抗原125(CA125)、子宫内膜厚度、血流信号及子宫内膜阻力指数(RI)均为发生癌前病变及癌变的影响因素。进一步多因素分析提示肥胖、空腹血糖升高、血流信号丰富、内膜增厚、乳腺增生及绝经后阴道出血/流液均是发生癌前病变及癌变的危险因素。列线图预测模型的ROC曲线下面积为0.956(95%CI:0.911,1.000)显著高于单个指标的区分度。结论:肥胖、空腹血糖升高、血流信号丰富、内膜增厚、合并乳腺增生及绝经后阴道出血/流液的绝经后内膜息肉女性更易发生癌前病变及癌变。列线图模型对于个体化评估EP风险具有一定临床应用价值。

Objective:To investigate the risk factors of precancerous lesions and canceration in postmenopausal women with endometrial polyps(EP),and to construct a risk prediction model.Method:Retrospective analysis was made on the operation data of 106 patients in the Gynecology Department of Sanming First Hospital from January 2017 to January 2021 with endometrial polyps indicated by color ultrasound after menopause.According to the pathological results,the patients were divided into benign lesion group(83 cases)and precancerous lesion/canceration group(23 cases).The general data,complications,test results and color Doppler ultrasound results of the two groups were analyzed by single factor analysis,high-risk factors were screened,constructed an nomogram prediction model and the discrimination of the prediction model was evaluated using ROC curve.Result:Univariate analysis suggested that body mass index(BMI),obesity,whether there was abnormal endometrial bleeding,whether there was vaginal bleeding/flow fluid after menopause,hyperplasia of mammary gland,triglyceride,fasting blood glucose,carbohydrate antigen 125(CA125),endometrial thickness,blood flow signal and endometrial resistance index(RI)were all the influencing factors for precancerous lesions and canceration.Further multivariate analysis suggested that obesity,elevated fasting glucose,rich blood flow signals,endometrial thickening,hyperplasia of mammary gland and vaginal bleeding/flow fluid after menopause were all risk factors for precancerous lesions and canceration.The area under the ROC curve of the nomogram prediction model was 0.956(95%CI:0.911,1.000),which was significantly higher than the differentiation of a single index.Conclusion:Postmenopausal endometrial polyps with obesity,elevated fasting glucose,rich blood flow signals,endometrial thickening,hyperplasia of mammary gland and vaginal bleeding flow/fluid after menopause are more likely to develop precancerous lesions and canceration.The line chart model has certain clinical application value for individualized assessment of EP risk.