Laurelli Giuseppe, Falcone Francesca, Gallo Maria Stella, Scala Felice, Losito Simona, Granata Vincenza, Cascella Marco, Greggi Stefano
*Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS; †Department of Woman, Child, and General and Specialized Surgery, Seconda Università degli Studi di Napoli; and ‡Surgical Pathology Unit, §Radiology Unit, and ‖Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy.
Int J Gynecol Cancer. 2016 Nov;26(9):1650-1657. doi: 10.1097/IGC.0000000000000825.
This study aimed to analyze the long-term oncologic and reproductive outcomes in endometrial cancer (EC) in young patients conservatively treated by combined hysteroscopic resection (HR) and levonorgestrel intrauterine device (LNG-IUD).
Twenty-one patients (age ≤ 40 years; Stage IA, G1-2 endometrioid EC), wishing to preserve their fertility, were enrolled into this prospective study. The HR was used to resect (1) the tumor lesion, (2) the endometrium adjacent to the tumor, and (3) the myometrium underlying the tumor. Hormonal therapy consisted of LNG-IUD (52 mg) for at least 6 months.
The median follow-up time is 85 months (range, 30-114). After 3 months from the progestin start date, 18 patients (85.7%) showed a complete regression (CR), 2 (9.5%) showed persistent disease, whereas 1 patient (4.8%) presented with progressive disease and underwent definitive surgery (Stage IA, G3 endometrioid). At 6 months, 1 of the 2 persistences underwent definitive surgery (Stage IA, G1 endometrioid), whereas the other was successfully re-treated. Two recurrences (10.5%) were observed, both involving the endometrium and synchronous ovarian cancer (OC) (atypical hyperplasia and Stage IIB G1 endometrioid OC; Stage IA endometrioid G1 EC, and Stage IA G1 endometrioid OC). The median duration of complete response was 85 months (range, 8-117). Sixty-three percent of complete responders attempted to conceive with 92% and 83% pregnancy and live birth rates, respectively. To date, all patients are alive and have no evidence of disease.
After a long follow-up, combined HR and LNG-IUD would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive. This approach is still experimental and should be offered only in the framework of scientific protocols conducted in cancer centers.
本研究旨在分析采用宫腔镜切除术（HR）联合左炔诺孕酮宫内节育器（LNG-IUD）对年轻子宫内膜癌（EC）患者进行保守治疗后的长期肿瘤学和生殖结局。
21例希望保留生育能力的患者（年龄≤40岁；IA期，G1-2级子宫内膜样EC）纳入本前瞻性研究。采用HR切除（1）肿瘤病灶，（2）肿瘤相邻的子宫内膜，以及（3）肿瘤下方的肌层。激素治疗采用LNG-IUD（52mg）至少6个月。
中位随访时间为85个月（范围30-114个月）。从孕激素开始使用日期起3个月后，18例患者（85.7%）显示完全缓解（CR），2例（9.5%）显示疾病持续存在，而1例患者（4.8%）出现疾病进展并接受了根治性手术（IA期，G3级子宫内膜样）。6个月时，2例持续存在的患者中有1例接受了根治性手术（IA期，G1级子宫内膜样），而另1例成功接受了再次治疗。观察到2例复发（10.5%），均累及子宫内膜并伴有同步性卵巢癌（OC）（非典型增生和IIB期G1级子宫内膜样OC；IA期子宫内膜样G1级EC和IA期G1级子宫内膜样OC）。完全缓解的中位持续时间为85个月（范围8-117个月）。63%的完全缓解者尝试受孕，妊娠率和活产率分别为92%和83%。迄今为止，所有患者均存活且无疾病证据。
经过长期随访，HR联合LNG-IUD似乎可提高单纯孕激素治疗的疗效。尝试受孕的女性中观察到较高的妊娠率和活产率。这种方法仍处于试验阶段，应仅在癌症中心开展的科学方案框架内提供。
