伴乳腺癌史绝经后女性发生子宫内膜病变的影响因素分析

Analysis of risk factors of endometrial lesions in postmenopausal women after breast cancer surgery

目的探讨伴乳腺癌史的绝经后女性发生子宫内膜病变的影响因素。方法回顾性收集2015年1月至2021年1月北京大学人民医院收治的141例伴乳腺癌史的绝经后发生子宫内膜病变患者的临床病理资料。结果141例患者术后病理提示子宫内膜良性病变占94.33%(133/141),其中正常子宫内膜占22.70%(32/141),子宫内膜息肉占65.96%(93/141)、不伴有不典型的子宫内膜增生占5.67%(8/141),子宫内膜癌占5.67%(8/141)。其发生的子宫内膜病变与患者有无异常子宫出血及子宫内膜厚度有关(P<0.05)。141例患者中,71.63%(101/141)接受内分泌治疗,其中47.52%(67/141)接受选择性雌激素受体(ER)调节剂治疗,24.11%(34/141)接受芳香酶抑制剂治疗。异常子宫出血预测伴乳腺癌史的接受选择性ER调节剂治疗的绝经后患者发生子宫内膜癌敏感度为66.7%,特异度为88.3%;子宫内膜厚度预测伴乳腺癌史的接受选择性ER调节剂治疗的绝经后患者发生子宫内膜癌的最佳临界值为1.25 cm,敏感度为66.7%,特异度为85%。结论异常子宫出血、子宫内膜增厚是伴乳腺癌史的绝经后患者发生子宫内膜病变的高危因素,对子宫内膜癌发生具有良好的预测价值。

Objective To investigate the risk factors of endometrial cancer in postmenopausal women after breast cancer surgery.Methods The clinical dates of 141 postmenopausal women after breast cancer surgery with endometrial diseases admitted to Peking University People's Hospital from January 2015 to January 2021 were retrospectively analyzed.Results Among the 141 patients,the postoperative pathology of 94.33%(133/141)cases were benign endometrial lesions,including 22.70%(32/141)cases of normal endometrium,65.96%(93/141)cases of endometrial polyps and 5.67%(8/141)cases of endometrial hyperplasia,the postoperative pathology of 5.67%(8/141)cases were endometrial cancer.The abnormal uterine bleeding and endometrial thickness were related to the occurrence of endometrial disease(P<0.05).Of the 141 patients,71.63%(101/141)received endocrine therapy after surgery,47.52%(67/141)of which received selective estrogen receptor modulators therapy and 24.11%(34/141)received aromatase inhibitor therapy.In postmenopausal women receiving selective estrogen receptor modulators therapy after breast cancer surgery,the sensitivity of abnormal uterine bleeding to predict endometrial cancer is 66.7%,and the specificity is 88.3%;the best cut-off value of endometrial thickness for predicting endometrial cancer is 1.25 cm with the sensitivity and specificity to endometrial cancer being 66.7%and 85%,respectively.Conclusions Abnormal uterine bleeding and endometrial thickening are high-risk factors for endometrial cancer in postmenopausal women after breast cancer surgery,and have promising predictive value for the occurrence of endometrial lesions.