Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Int J Gynecol Cancer. 2013 Feb;23(2):288-93. doi: 10.1097/IGC.0b013e31827c18a1.
Many patients with endometrial cancer have no children when diagnosed, and thus are reluctant to undergo hysterectomy, hoping to preserve their fertility. Their requirement is met, at least partially, with high-dose medroxyprogesterone acetate that brings good response rate in the treatment of endometrial cancer in the early stage and atypical complex endometrial hyperplasia (EC/ACEH). Actually, a number of successful pregnancies after the conservative treatment have been reported. To conceive, many of them need infertility treatment because of ovulation disorders which might have induced the cancer with unopposed estrogens. However, on the other side, hyperestrogenic status caused by ovulation induction or controlled ovarian stimulation might promote the progression and the recurrence of the disease.
This study aimed to assess the effectiveness and safety of infertility treatment after conservative therapy for EC/ACEH, to confirm the significance of fertility-sparing therapy.
The patients with EC/ACEH who achieved complete response after high-dose medroxyprogesterone acetate were eligible for this retrospective study. Characteristics of the patients, whether they underwent infertility treatment, conceived, or relapsed, and the interval from complete response to conception or recurrence were retrospectively analyzed.
The clinical outcomes of 36 patients were investigated. Twenty-six of them desired to conceive soon after complete response. All of them underwent infertility treatment, and 16 women delivered healthy babies. Kaplan-Meyer curve and log-rank test analysis revealed that women who achieved live birth had a significantly lower risk of recurrence than those without live birth. There was not a significant difference between the patients with and without infertility treatment.
Use of ovulation induction drugs after conservative treatment of endometrial cancer did not increase the recurrence of the disease. Moreover, resulting pregnancy seems to have an advantageous effect on the oncologic outcome.
许多子宫内膜癌患者在确诊时还没有生育子女，因此不愿意接受子宫切除术，希望保留生育能力。他们的需求可以通过大剂量醋酸甲地孕酮得到满足，这种药物在治疗早期子宫内膜癌和非典型复杂子宫内膜增生（EC/ACEH）方面有很好的反应率。实际上，已经有许多在保守治疗后成功怀孕的报道。为了怀孕，他们中的许多人需要不孕治疗，因为排卵障碍可能导致癌症与雌激素无拮抗。然而，另一方面，排卵诱导或控制性卵巢刺激引起的高雌激素状态可能会促进疾病的进展和复发。
本研究旨在评估 EC/ACEH 保守治疗后不孕治疗的有效性和安全性，以确认保留生育能力治疗的意义。
符合条件的患者为接受大剂量醋酸甲地孕酮治疗后完全缓解的 EC/ACEH 患者。回顾性分析患者的特征、是否接受不孕治疗、受孕、复发以及完全缓解后到受孕或复发的间隔时间。
对 36 例患者的临床结局进行了调查。其中 26 例患者在完全缓解后渴望尽快怀孕。他们都接受了不孕治疗，其中 16 名女性产下了健康的婴儿。Kaplan-Meier 曲线和对数秩检验分析显示，活产的女性复发风险明显低于未活产的女性。有生育治疗和没有生育治疗的患者之间没有显著差异。
在子宫内膜癌的保守治疗后使用促排卵药物不会增加疾病的复发。此外，由此产生的妊娠似乎对肿瘤学结果有有利影响。
