Epidemiology and treatment outcomes of endometrial hyperplasia and cancer: A population-based investigation using routine administrative data

子宫内膜增生和癌症的流行病学和治疗结果：使用常规管理数据进行的基于人群的调查

• 批准号: MR/T019859/1
• 负责人: Úna McMenamin
• 金额: $ 114.7万
• 依托单位: Queen's University Belfast
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT019859%2F1
• 关键词: Epidemiology; treatment; outcomes; endometrial; hyperplasia

Endometrial cancer is the most commonly diagnosed gynaecological cancer and is the 4th most common cancer in UK women. Endometrial cancer rates have increased substantially; in the UK over 9,000 cases occur annually and rates have increased by over 50% over the past 20 years. Factors associated with prolonged oestrogen exposure are thought to be driving this including the dramatic increase in obesity rates and shifts in reproductive trends, e.g. delaying childbirth until later in life. There is no routine screening for endometrial cancer but endometrial hyperplasia, a recognised precursor, offers an opportunity for prevention, but little is known about its natural history and associated outcomes. Removal of the uterus (hysterectomy) is the primary treatment for endometrial cancer and some types of endometrial hyperplasia but there is a need to evaluate the long-term benefits and risks of fertility-sparing therapies, considering the alarming increases in endometrial cancer in premenopausal women.This research will answer three primary research questions:1. Which women are most at risk of progression from endometrial hyperplasia to cancer?2. What is the impact of non-surgical, fertility-sparing therapies on future cancer risk and reproductive outcomes in endometrial hyperplasia patients? 3. What are the international trends in surgical and non-surgical treatments of endometrial cancer and how do these impact upon survival outcomes? A pilot endometrial hyperplasia register, located within the Northern Ireland Cancer Registry (NICR), will be utilised and expanded upon to make it one of the world's largest endometrial hyperplasia registers. The register will be linked to NICR records to determine temporal trends in endometrial hyperplasia incidence and progression to endometrial cancer. Medical note reviews will provide details on patient and clinico-pathological factors while additional novel data linkages to drug dispensing and maternity records in Northern Ireland (NI) will be conducted to evaluate, for the first time, population patterns of low-cost progestogen therapies (delivered orally or, more recently via intrauterine devices) in endometrial hyperplasia patients and their long-term impact on clinical outcomes such as hysterectomy, live births and progression to cancer. Using population-based linked data sources, accessed from established research links, European trends in the use of surgical and non-surgical treatments for endometrial cancer will be determined for the first time according to geography and healthcare systems. Pooled analyses of large endometrial cancer cohorts from the UK, Belgium and the Netherlands will be conducted to evaluate survival outcomes according to non-surgical, progestogen-based therapies. Future research will explore the development of patient decision aid tools to enable better informed joint treatment decision making. The involvement of patients and clinicians throughout will ensure that the research is clinically relevant. This research programme will generate robust population-level evidence to inform diagnostic, treatment and surveillance strategies for women with endometrial hyperplasia and endometrial cancer and will ultimately lead to better informed clinical decision-making between women and their health care professionals.

子宫内膜癌是最常见的妇科癌症，并且是英国女性第四大癌症。子宫内膜癌的发生率大大增加；在英国，每年发生9,000起超过9,000例，在过去20年中，利率增加了50％以上。人们认为与延长的雌激素暴露有关的因素驱动了这一点，包括肥胖率的急剧增加和生殖趋势的转移，例如将分娩延迟到生命的后期。子宫内膜癌没有常规筛查，但是子宫内膜增生是一种公认​​的前体，为预防提供了机会，但对其自然历史和相关结果知之甚少。去除子宫（子宫切除术）是子宫内膜癌和某些类型的子宫内膜增生的主要治疗方法，但是考虑到术后妇女的子宫内膜癌的令人震惊的增加，需要评估长期益处和养育生育能力的疗法的风险。哪些女性最有从子宫内膜增生到癌症的风险？2。非外科生育能力疗法对子宫内膜增生患者的未来癌症风险和生殖结果有什么影响？ 3。子宫内膜癌的外科和非手术治疗的国际趋势是什么？这些对生存结果的影响如何？位于北爱尔兰癌症登记处（NICR）内的子宫内膜增生登记册将被利用并扩展，以使其成为世界上最大的子宫内膜增生登记册之一。该寄存器将与NICR记录联系起来，以确定子宫内膜增生发生率的时间趋势和向子宫内膜癌的发展。医学票据审查将提供有关患者和临床病理学因素的详细信息，同时，将进行其他新的数据联系，与北部爱尔兰（NI）的药物分配和产妇记录联系起来，将首次评估低成本孕激素疗法的人口模式（在口头上或最近通过腹膜内的患者进行了临时性的临床效果），以​​进行低成本孕激素疗法的人口模式，以评估临床上的临床上的临时性影响。和癌症的进展。使用基于人群的链接数据源，从既定的研究联系中访问，将首次根据地理和医疗保健系统，首次确定使用手术和非手术治疗用于子宫内膜癌的欧洲趋势。将根据非手术，基于孕激素的疗法对来自英国，比利时和荷兰的大型子宫内膜癌队列的汇总分析进行评估。未来的研究将探讨患者决策工具的开发，以实现更好的知情联合治疗决策。患者和临床医生的参与将确保研究在临床上具有相关性。该研究计划将为患有子宫内膜增生和子宫内膜癌的妇女提供良好的人群级证据，以告知诊断，治疗和监测策略，并最终导致妇女及其医疗保健专业人员之间的临床决策更好。

项目成果

Medications, sex hormones and reproductive factors in relation to gastro-oesophageal cancer risk and survival

与胃食管癌风险和生存相关的药物、性激素和生殖因素

• 发表时间: 2021
• 作者: Liu P

Exposure to weak opioids and risk of gastrointestinal tract cancers: A series of nested case-control studies.

接触弱阿片类药物和胃肠道癌症的风险：一系列巢式病例对照研究。

• DOI: 10.1111/bcp.15759
• 发表时间: 2023
• 期刊: British journal of clinical pharmacology
• 影响因子: 3.4
• 作者: Houston MG

Hormone therapy use and the risk of acute kidney injury in patients with prostate cancer: a population-based cohort study.

• DOI: 10.1038/s41391-021-00348-x
• 发表时间: 2021-12
• 期刊: Prostate cancer and prostatic diseases
• 影响因子: 4.8
• 作者: Cardwell CR;O'Sullivan JM;Jain S;Hicks BM;Devine PA;McMenamin ÚC
• 通讯作者: McMenamin ÚC

Hormone replacement therapy in women with cancer and risk of cancer-specific mortality and cardiovascular disease: a protocol for a cohort study from Scotland and Wales.

• DOI: 10.1186/s12885-021-08065-3
• 发表时间: 2021-03-24
• 期刊: BMC cancer
• 影响因子: 3.8
• 作者: McMenamin Ú;Hicks B;Hughes C;Murchie P;Hippisley-Cox J;Ranger T;Coupland C;Cardwell C
• 通讯作者: Cardwell C

Circulating Sex Hormones Are Associated With Gastric and Colorectal Cancers but Not Esophageal Adenocarcinoma in the UK Biobank.

• DOI: 10.14309/ajg.0000000000001045
• 发表时间: 2021-03-01
• 期刊: The American journal of gastroenterology
• 作者: McMenamin ÚC;Liu P;Kunzmann AT;Cook MB;Coleman HG;Johnston BT;Cantwell MM;Cardwell CR
• 通讯作者: Cardwell CR