Analysis Of Clinical Factors Of Postoperative Pathological Progression To Endometrial Carcinoma In Patients With Endometrial Atypical Hyperplasia

Objective: To analyze the clinical factors associated with postoperative pathological progression of endometrial carcinoma in patients with endometrial atypical hyperplasia diagnosed preoperatively.To provide reference and theoretical basis for the diagnosis and treatment of endometrial atypical hyperplasia,and reduce the rate of missed diagnosis of endometrial cancer.Methods: The clinical and pathological data of 100 patients with endometrial atypical hyperplasia who met the inclusion and exclusion criteria were retrospectively collected.According to the pathological results after total hysterectomy,the patients were divided into two groups: endometrial atypical hyperplasia（AH）group and endometrial carcinoma（EC）group.（1）The pathological results of patients in the AH group and THE EC group before and after surgery were counted,and the clinical value of preoperative atypical growth score in evaluating postoperative pathological upgrading was analyzed;（2）The diagnostic coincidence rate of the two preoperative endometrial sampling methods was compared;（3）The general situation,gynecological tumor markers,inflammatory related indicators and metabolic related indicators of patients in AH group and EC group were compared.Statistical methods were used for analysis and comparison,and multivariate regression analysis was conducted for the meaningful indicators,and ROC curve was drawn to evaluate their predictive value in postoperative pathological progression of patients with endometrial atypical hyperplasia.Results:1.Among the 100 cases of endometrial dysplasia,45 patients experienced postoperative pathological escalation.In EC group,8 cases,12 cases and 25 cases were diagnosed as mild,moderate and severe endometrial dysplasia before surgery,respectively.The higher the preoperative pathological grade was,the higher the possibility of postoperative pathological escalation was.2.In the EC group,all postoperative pathological types were endometrioid adenocarcinoma,and 37 cases（82.22%）were stage IA,and 26 cases（57.78%）were highly differentiated.3.There were significant differences in BMI and course of disease between AH group and EC group（P < 0.05）.Multivariate analysis showed that BMI（OR=1.188,95%CI: 1.016-1.388,P=0.031）were independent risk factors for postoperative pathological progression in patients with atypical hyperplasia（P < 0.05）,but the course of disease was not（P > 0.05）.The ROC results of BMI assessment of postoperative pathological progression showed that AUC was 0.591(95%CI: When the cut-off value was 25.48kg/m2,the sensitivity and specificity were 48.9% and 76.4% respectively.4.The elevation of CA125（CA125≥35 U/ m L）was significantly different between the AH group and the EC group（P < 0.05）.Multivariate analysis showed that the elevation of CA125 was not an independent risk factor for pathological progression（P > 0.05）.5.There were statistically significant differences in PDW,HCY and UA between AH group and EC group（P < 0.05）.Multivariate analysis showed that UA（OR=1.011,95%CI: 1.003-1.019,P=0.009）was an independent risk factor for postoperative pathological progression（P < 0.05）,while PDW and HCY were not.The ROC results of UA in evaluating postoperative pathological progression showed an AUC of 0.658（95%CI: 0.551-0.765）and a Youden index of 0.255.When the cut-off value was228μmol/L,the sensitivity and specificity of diagnosis were 80.0% and 45.5%,respectively.6.The AUC of the combined assessment of BMI and UA for postoperative pathological escalation was 0.701（95%CI: 0.597-0.804）,the Yoden index was 0.338,the sensitivity was 55.6%,and the specificity was 78.2%.7.Age,age of menarche,extremity,history of pregnancy and childbirth,complications（hypertension,diabetes）and other indicators have little significance for evaluating postoperative pathological escalation.Conclusions: 1.Preoperative atypical hypertrophic score affects postoperative pathological progression.With the aggravation of pathological grading,the risk of pathological progression increases.2.Patients with pathological progression were mainly endometrioid adenocarcinoma after surgery,most of which were in early stage and well differentiated;3.The increase of preoperative BMI and serum uric acid in patients with endometrial atypical hyperplasia was related to postoperative pathological escalation,and the optimal cut-off values for the evaluation of postoperative pathological escalation were 25.48 kg/m2 and 228μmol/L,respectively.