少数族裔人群中非典型子宫内膜增生患者合并子宫内膜癌风险的单中心研究
该单中心回顾性研究纳入2014至2022年因非典型子宫内膜增生（AEH）行子宫切除术的123例患者（45%西班牙裔、22%黑人），56%合并子宫内膜癌（EC）。多因素分析显示高血压增加EC风险，合并子宫腺肌症或内膜息肉降低EC风险；可评估的62例EC中39%符合Mayo标准（总体风险21%），内膜回声≥2cm与符合Mayo标准风险升高相关。
要点
- AEH患者子宫切除时合并EC率达56%，高于既往报道。
- 高血压增加EC风险（OR 5.52），子宫腺肌症和内膜息肉降低EC风险。
- 可评估EC中39%符合Mayo标准（总体风险21%），内膜回声≥2cm与风险升高相关。
核心结论
- 在少数族裔富集的城乡人群中，AEH患者子宫切除时EC发生率及符合Mayo标准的淋巴结受累风险高于既往报道。
- 子宫腺肌症与更好的预后相关，未发现种族/族裔差异，但医疗不平等因素负面影响癌症概率和风险分层。
研究设计与样本
- 单中心回顾性分析，纳入2014至2022年因AEH行子宫切除术的123例患者，采用单因素和多因素回归建模。
主要发现
- 123例AEH患者中56%在子宫切除时合并EC（45%西班牙裔、22%黑人、20%其他、13%未披露）。
- 多因素模型中，高血压增加EC风险（OR 5.52，95% CI 1.56-19.62），子宫腺肌症（OR 0.26，95% CI 0.07-0.91）和内膜息肉（OR 0.25，95% CI 0.08-0.81）降低EC风险。
- 可评估的62例EC中24例（39%）符合Mayo标准，总体风险21%；缺乏既往医疗护理（p=0.047）增加符合Mayo标准的可能性。
- 多因素模型中，内膜回声≥2cm与符合Mayo标准风险升高相关（OR 13.22，95% CI 1.62-108.17），子宫腺肌症存在与符合Mayo标准的癌症负相关（OR 0.22，95% CI 0.05-0.98）。
关键数值与推荐
- Mayo标准用于定义淋巴结受累风险，可评估EC中39%符合，总体风险21%。
- 高血压OR 5.52（95% CI 1.56-19.62），子宫腺肌症OR 0.26（95% CI 0.07-0.91），内膜息肉OR 0.25（95% CI 0.08-0.81）。
- 内膜回声≥2cm OR 13.22（95% CI 1.62-108.17），子宫腺肌症与符合Mayo标准癌症OR 0.22（95% CI 0.05-0.98）。
临床怎么用
- 对AEH患者行子宫切除前应评估高血压、子宫腺肌症和内膜息肉等合并情况以辅助风险分层。
- 内膜回声≥2cm提示需警惕符合Mayo标准的EC风险，应关注淋巴结评估。
- 应识别缺乏既往医疗护理等医疗不平等因素，其可能影响癌症概率和风险分层。
局限性
- 单中心回顾性研究，样本量有限，结论外推需谨慎。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To identify clinicopathologic predictors of concurrent endometrial carcinoma (EC) and need for lymph node assessment at time of hysterectomy for atypical endometrial hyperplasia (AEH) in a minority-enriched population. METHODS: Retrospective analysis of AEH cases treated definitively via hysterectomy at a single urban center from 2014 to 2022. Demographic and clinicopathologic characteristics were analyzed using univariate and multivariate regression modeling to identify independent risk factors. RESULTS: 123 AEH patients (45% Hispanic, 22% Black, 20% non-Black/non-Hispanic other, 13% undisclosed) were included; 56% with EC at hysterectomy. In the multivariate model, hypertension increased EC odds (OR 5.52, 95% CI 1.56-19.62). Concurrent adenomyosis (OR 0.26, 95% CI 0.07-0.91) and endometrial polyps (OR 0.25, 95% CI 0.08-0.81) were independently associated with reduced EC odds. Of the 62 EC cases evaluable, 24 (39%) met Mayo criteria on final histopathologic review, representing an overall 21% likelihood risk. Lack of antecedent medical care (p = 0.047) increased likelihood of meeting Mayo criteria. In the multivariate model, endometrial echogenicity (EE) ≥2 cm was associated with increased odds of meeting Mayo criteria (OR 13.22, 95% CI, 1.62-108.17), while adenomyosis presence was negatively associated with concurrent cancer meeting Mayo criteria (OR, 0.22, 95% CI, 0.05-0.98). CONCLUSIONS: In an underrepresented urban population, rates of EC and patients at risk for nodal involvement as defined by Mayo criteria are higher than previously reported. Novel investigation of other intrauterine pathologies demonstrated association of adenomyosis with improved prognosis. No racial/ethnic differences were found in this single-center experience. Factors associated with inequity, however, negatively impact cancer probability and risk stratification.
引用
- Soiffer JL, Suresh D, Jalai C, et al. Risk of endometrial carcinoma in patients with atypical endometrial hyperplasia in a population of predominantly racial and ethnic minorities, a single institution study. Gynecol Oncol. 2026. PMID: 42217257. doi:10.1016/j.ygyno.2026.05.020
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。