| Objectives:The aim of this paper is to investigate the risk factors of endometrial cancer, the clinical significance of the diagnostic curettage, and to discuss the appropriate diagnostic and treatment strategy for endometrial cancer.Methods:The medical records of217consecutive patients with postmenopausal vaginal bleeding at our department, from July2006to June2011, were reviewed retrospectively. All the bleeding cases occurred in cervix, ovary or vaginal were excluded.The clinical data were collected and then divided into two groups which were the tumorous group and non-tumorous group, according to the post-operative pathology results. Characteristics of different groups were compared. The Statistical Package for Social Sciences was used to handle the database. The independent t-test was used to compare means χ2test was applied to compare the differences among the different groups. When20%of cells had expected counts of less than five, Fisher’s exact test was used. A multivariate logistic regression model was constructed to evaluate the relationship between clinical characteristics and the occurrence of endometrial cancer. The sensitivity, specificity and Youden’s index were analyzed and the receiver operating characteristic curve (ROC curve) were applied to estimate the clinical diagnostic significance of the diagnostic curettage,. Two-sided P<0.05was considered to indicate statistically significant differences.Outcome:There were176cases in the tumorous group and41cases in the non-tumorous group accounting for81.11%and28.89respectively of the217patients. The mean age, menopausal age and menopausal year was59.44years (42-82years),50.1years (37-60years) and9.3years (1-38years), respectively.The risk factors of endometrial cancer:Of the tumorous group, the mean age, menopausal age, menopausal year and the age of last production was (59.56±6.72) years,(50.98±3.50) years,(9.22±6.55) years and (28.85±3.86) years, respectively while of the non-tumorous group it was (58.93±7.67) years,(49.24±4.43) years,(9.68±8.49) years and (29.05±3.23) years, respectively. There was statistically significant difference in the mean menopausal age between these two groups (P=0.007). The mean endometrial thickness of the tumorous group and non-tumorous group was13.00±7.86) mm and (9.11±4.78) mm, respectively, which showed statistically significant difference (P<0.001). There were statistically significant difference of the patients who suffered from hypertension and diabetes between the two groups (P=0.029and P=0.001, respectively). Univariate non-conditional logistic regression model analysis was applied to recognize the potential risk factors. Significative ones were analyzed by multivariate logistic regression model. The menopausal age [OR=1.11,95%C.I (1.01,1.23)], endometrial thickness [OR=2.96,95%C.I (1.32,6.65)], hypertension [OR=2.14,95%C.I (1.02,4.46)] and diabetes [OR=5.54,95%C.I(1.23,24.84)] were all risk factors of endometrial cancer.The validity of the biopsy result:①Atypical hyperplasia was classified into benign lesion:the sensitivity, specificity of biopsy and Youden’s index was68.18%(120/176)and70.73%(29/41), respectively. The area under an ROC curve (AUC)was0.695.②Atypical hyperplasia was classified into malignant lesion:the sensitivity, specificity of biopsy and Youden’s index was96.20%(177/184),57.58%(19/33) and0.54, respectively. The area under an ROC curve (AUC) was0.769.57cases of tumor group accept the abdominal hysterectomy and bilateral salpingo-oophorectomy,116cases more were dissected lymph nodes in addition, and3patients were given the cytoreductive surgery. In the non-tumor group,4cases accept endometrial electrotomy and polyps enucleation,26cases accept the hysterectomy, and11cases more were dissected lymph nodes in addition.Besides of the cytoreductive surgery,4cases of127patients whose lymph nodes were dissected were infiltrated,with the positive rate of3.15%only.Conclusions:1. High blood pressure, diabetes,and endometrial thickness were risk factors of the endometial cancer. If women who suffered vaginal bleeding after menopause, were with the complication of hypertension or diabetes or with thickening endometrium, they should be followed up as high-risk groups actively.2. Postmenopausal vaginal bleeding is a danger signal of endometrial cancer. Patients who have these symptoms should received the diagnostic curettage, even though this method may encounter misdiagnosis and omission diagnosis. Moreover, it is not the only diagnostic criteria of endometrial cancer before the operation. Treating atypical hyperplasia as cancer, will increase the rate of coincidence and decrease the omission diagnostic rate enormously. However, the rate of misdiagnosis will go up at the same time. The endometrial thickness can be regarded as an discrimination between benign and malignant endometrial disease.3. Most patients of endometrial cancer with the symptom of postmenopausal vaginal bleeding are in the early stage and with high histological differentiation. Therefore, the surgical strategy for these patients should not include lymphatic resection as a routine procedure, unless in high risk conditions (middle-late stage, low differentiation, abdominal rinsed cytology positive, etc.)... |
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