Risk factors for endometrial hyperplasia and cancer among women with abnormal bleeding
Risk factors for endometrial hyperplasia and cancer among women with abnormal bleeding
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DOI：
10.1016/s0029-7844(98)00469-4
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发表时间：
1999-04-01
影响因子：
7.2
通讯作者：
Belinson, JL
中科院分区：
文献类型：
--
作者：
Weber, AM;Belinson, JL
目的：确定围绝经期或绝经后异常出血妇女子宫内膜瘤变的独立危险因素，并利用这些因素建立和检验预测模型。方法：我们对有子宫内膜取样的围绝经期或绝经后异常出血的妇女进行病例对照研究；病例为子宫内膜癌或复杂增生，对照组为子宫内膜良性组织。多变量logistic回归模型确定了与子宫内膜瘤变风险相关的因素。我们的模型和已发表的模型的预测能力通过受试者工作特征（ROC）曲线下的面积进行评估，其中1.0的面积表示完全阳性预测能力，0.5的面积是偶然期望的。结果：子宫内膜增生或消失57例，对照组137例。胎次与子宫内膜瘤的风险呈负相关（比值比[OR] 0.70； 95%可信区间[CI] 0.56, 0.88; P = 0.002），体重与子宫内膜瘤的风险直接相关（比值比[OR] 1.02 / kg; 95% CI 1.01, 1.04; P = 0.018）。年龄（OR 1.04 /年；95% CI 1.00, 1.08; P = 0.06）和糖尿病（OR 3.50; 95% CI 0.99, 12.33; P = 0.052）的差异有统计学意义。模型的ROC曲线下面积为0.75，预测能力中等；已发表模型的ROC曲线下面积较低，为0.66。结论：目前基于病例对照研究的临床预测模型没有足够的预测能力来确定绝经期或绝经后异常出血的妇女是否应该进行诊断检测。（妇产科，1999;93:594-8）(C) 1999年由美国妇产科医师学会出版。
Objective: To identify independent risk factors for endometrial neoplasia in women with abnormal perimenopausal or postmenopausal bleeding and to use those factors to develop and test a predictive model.Methods: We conducted a case-control study of women with abnormal perimenopausal or postmenopausal bleeding who had endometrial samplings; cases had endometrial cancer or complex hyperplasia and controls had benign endometrial histologies. Multivariate logistic regression models identified factors associated with risks of endometrial neoplasia. The predictive abilities of our models and a published model were assessed wing the area under receiver operating characteristic (ROC) curves, for which an area of 1.0 indicated perfect positive predictive ability and an area of 0.5 was expected by chance.Results: There were 57 cases of endometrial hyperplasia or cancel and 137 controls. Parity was related inversely (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.56, 0.88; P = .002) and weight directly (OR 1.02 per kg; 95% CI 1.01, 1.04; P = .018) to the risk of endometrial neoplasia. Age (OR 1.04 per year; 95% CI 1.00, 1.08; P = .06) and diabetes (OR 3.50; 95% CI 0.99, 12.33; P = .052) were significant marginally. The area under the ROC curve for our model was 0.75, indicating moderate predictive ability; the area under the ROC curve for the published model was lower at 0.66.Conclusion: Current clinical predictive models based on case-control studies do not have sufficient predictive ability to determine if women with abnormal perimenopausal or postmenopausal bleeding should have diagnostic testing. (Obstet Gynecol 1999;93:594-8. (C) 1999 by The American College of Obstetricians and Gynecologists.).