Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
Am J Obstet Gynecol. 2014 Mar;210(3):255.e1-4. doi: 10.1016/j.ajog.2013.11.001. Epub 2013 Nov 8.
This study evaluated fertility and oncological outcomes in women with complex atypical hyperplasia (CAH) or nonmyoinvasive grade 1 endometrioid endometrial carcinoma (EM) who desired fertility-sparing therapy.
The retrospective cohort study included women younger than 45 years with CAH or EM who desired fertility-sparing treatment at our institution. Only patients for whom both oncological treatment and pregnancy outcomes were available were included. Statistical analyses were performed using a Fisher exact test, Pearson χ(2) test, and Spearman rank correlation test, as appropriate.
Seventy-five patients were identified, and 23 (13 CAH, 10 EM) met the inclusion criteria. All 23 patients had at least 1 prior pregnancy. Treatment was split between oral progesterone only (38.5% CAH, 40% EM), levonorgestrel intrauterine device only (30.8% CAH, 20% EM), and both (30.8% CAH, 40% EM). After a median follow-up of 13 months (range, 3-74 months), 9 patients (46.2% CAH, 30% EM, P = .39) had persistent/progressive disease. Eight patients (30.8% CAH, 40% EM, P = .69) ultimately had a hysterectomy, and 3 of these (13.0%) were found to have persistent/progressive disease. Median time from diagnosis to hysterectomy was 13 months (range, 4-56 months). Fourteen of the 23 patients utilized assisted reproductive techniques (60.9%); 12 underwent IVF and 2 chose a gestation carrier. Seven clinical intrauterine pregnancies (30.4%) resulting in 6 live births (26.1%) were found in the entire cohort.
Fertility-sparing treatment for CAH and grade 1 endometrial cancer is feasible with progestin therapy and leads to clinically meaningful rates of pregnancy in young women who desire fertility.
本研究评估了有生育需求的复杂性非典型增生（CAH）或非浸润性 1 级子宫内膜样腺癌（EM）患者进行保留生育力治疗的生育能力和肿瘤学结局。
本回顾性队列研究纳入了在我院接受保留生育力治疗的年龄小于 45 岁的 CAH 或 EM 患者。仅纳入了可获得肿瘤治疗和妊娠结局的患者。统计分析采用 Fisher 确切检验、Pearson χ²检验和 Spearman 秩相关检验。
共确定了 75 例患者，其中 23 例（13 例 CAH，10 例 EM）符合纳入标准。所有 23 例患者均有至少 1 次既往妊娠。治疗方案分为单纯口服孕激素（38.5% CAH，40% EM）、单纯左炔诺孕酮宫内节育器（30.8% CAH，20% EM）和两者联合（30.8% CAH，40% EM）。中位随访时间为 13 个月（范围：3-74 个月），9 例（46.2% CAH，30% EM，P=0.39）患者疾病持续/进展。8 例（30.8% CAH，40% EM，P=0.69）患者最终行子宫切除术，其中 3 例（13.0%）发现疾病持续/进展。从诊断到子宫切除术的中位时间为 13 个月（范围：4-56 个月）。23 例患者中有 14 例（60.9%）采用了辅助生殖技术，其中 12 例行 IVF，2 例选择代孕。整个队列中发现 7 例临床宫内妊娠（30.4%），6 例活产（26.1%）。
孕激素治疗 CAH 和 1 级子宫内膜癌的保留生育力治疗是可行的，可使有生育需求的年轻女性获得有临床意义的妊娠率。
